Healthcare Provider Details

I. General information

NPI: 1033074133
Provider Name (Legal Business Name): GRAY HUNTER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 N LOMBARD ST
PORTLAND OR
97217-5737
US

IV. Provider business mailing address

4634 N CONCORD AVE UPPR UNIT
PORTLAND OR
97217-3327
US

V. Phone/Fax

Practice location:
  • Phone: 503-893-4407
  • Fax:
Mailing address:
  • Phone: 503-317-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29389
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: