Healthcare Provider Details

I. General information

NPI: 1275857740
Provider Name (Legal Business Name): ANNEMARIE COUGHLIN GRAY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 FORT SANDERS WEST BLVD STE 110
KNOXVILLE TN
37922-3355
US

IV. Provider business mailing address

260 FORT SANDERS WEST BLVD STE 110
KNOXVILLE TN
37922-3355
US

V. Phone/Fax

Practice location:
  • Phone: 865-558-4491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 0000001458
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1458
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: