Healthcare Provider Details

I. General information

NPI: 1619284247
Provider Name (Legal Business Name): ANITA DOREEN GRAYS MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 COUNTY RTE 32 SECO PO 1046
NORWICH NY
13815
US

IV. Provider business mailing address

1555 STATE HIGHWAY 357
UNADILLA NY
13849-2399
US

V. Phone/Fax

Practice location:
  • Phone: 607-334-5010
  • Fax: 607-336-7326
Mailing address:
  • Phone: 607-369-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012508
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: