Healthcare Provider Details

I. General information

NPI: 1396003554
Provider Name (Legal Business Name): BRITTANY ASHLEY GRAY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY ASHLEY GAZELLE PT, DPT

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N MAIN ST SUITE 1
GLASSBORO NJ
08028-1605
US

IV. Provider business mailing address

707 N MAIN ST SUITE 1
GLASSBORO NJ
08028-1605
US

V. Phone/Fax

Practice location:
  • Phone: 856-307-9700
  • Fax:
Mailing address:
  • Phone: 856-534-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01439800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: