Healthcare Provider Details

I. General information

NPI: 1164532016
Provider Name (Legal Business Name): JEREMY GRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 UNION ST
SHELBYVILLE TN
37160-2607
US

IV. Provider business mailing address

1515 DEWSBURY DR
MURFREESBORO TN
37128-2744
US

V. Phone/Fax

Practice location:
  • Phone: 931-685-5575
  • Fax: 931-685-5578
Mailing address:
  • Phone: 615-225-8385
  • Fax: 931-685-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: