Healthcare Provider Details

I. General information

NPI: 1578898052
Provider Name (Legal Business Name): JOSHUA RONALD GRAY C.T.R.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

PO BOX 351
GRAPEVIEW WA
98546-0351
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2638
  • Fax:
Mailing address:
  • Phone: 509-863-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number46630
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: