Healthcare Provider Details

I. General information

NPI: 1811841315
Provider Name (Legal Business Name): GRAY GAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 E 500 S STE 104
BOUNTIFUL UT
84010-6200
US

IV. Provider business mailing address

74 E 500 S STE 104
BOUNTIFUL UT
84010-6200
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-8222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number13208796-2402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: