Healthcare Provider Details

I. General information

NPI: 1649861071
Provider Name (Legal Business Name): TEDD GRAY DPT, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 S HIGHLAND DR
SALT LAKE CITY UT
84124-2603
US

IV. Provider business mailing address

4285 S HIGHLAND DR
SALT LAKE CITY UT
84124-2603
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-2839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11797529-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11797529-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: