Healthcare Provider Details

I. General information

NPI: 1205768769
Provider Name (Legal Business Name): STEPHANIE ELLEN GRAY V LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44419 TOWN CENTER WAY STE 134
PALM DESERT CA
92260-7100
US

IV. Provider business mailing address

44419 TOWN CENTER WAY STE A
PALM DESERT CA
92260-2704
US

V. Phone/Fax

Practice location:
  • Phone: 760-556-5781
  • Fax:
Mailing address:
  • Phone: 760-556-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number90287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: