Healthcare Provider Details

I. General information

NPI: 1184652422
Provider Name (Legal Business Name): ANNA GRAY MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE KEENEY MPT

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 SE DESTINATION DR
GRIMES IA
50111-1247
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 515-986-5190
  • Fax: 515-986-5194
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03519
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: