Healthcare Provider Details

I. General information

NPI: 1497865042
Provider Name (Legal Business Name): CHRISTIE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 S LOGAN ST
MISHAWAKA IN
46544-4739
US

IV. Provider business mailing address

51479 COUNTY ROAD 1
GRANGER IN
46530-5040
US

V. Phone/Fax

Practice location:
  • Phone: 574-257-8629
  • Fax:
Mailing address:
  • Phone: 517-278-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002635A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: