Healthcare Provider Details

I. General information

NPI: 1407946924
Provider Name (Legal Business Name): RAY GRAY RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W PALMDALE BLVD STE F
PALMDALE CA
93551-3104
US

IV. Provider business mailing address

450 W. PALMDALE BLVD SUITE F
PALMDALE CA
93551
US

V. Phone/Fax

Practice location:
  • Phone: 661-273-5333
  • Fax: 661-273-0033
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: