Healthcare Provider Details

I. General information

NPI: 1336002021
Provider Name (Legal Business Name): THERESA GRAY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 COLONIAL DR
AKRON PA
17501-1223
US

IV. Provider business mailing address

PO BOX 473
BROWNSTOWN PA
17508-0473
US

V. Phone/Fax

Practice location:
  • Phone: 717-681-3146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number005740
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: