Healthcare Provider Details

I. General information

NPI: 1558295857
Provider Name (Legal Business Name): KYLIE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

IV. Provider business mailing address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1012
  • Fax:
Mailing address:
  • Phone: 662-328-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8156
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: