Healthcare Provider Details

I. General information

NPI: 1700793858
Provider Name (Legal Business Name): JUSTYN KHALIL GRAY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 SW CARY PKWY
CARY NC
27513-8913
US

IV. Provider business mailing address

204 MATTHEWS DR
HOLLY SPRINGS NC
27540-4302
US

V. Phone/Fax

Practice location:
  • Phone: 919-913-8455
  • Fax: 919-913-8462
Mailing address:
  • Phone: 919-578-4200
  • Fax: 919-578-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25255
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: