Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W CHICAGO RD
STURGIS MI
49091-1709
US

IV. Provider business mailing address

315 N WALKER ST
BRONSON MI
49028-1041
US

V. Phone/Fax

Practice location:
  • Phone: 269-651-2550
  • Fax:
Mailing address:
  • Phone: 517-369-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: