=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497827513
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH A GRAY PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1033 LA POSADA DR SUITE 308
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78752-3842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-284-7192
-----------------------------------------------------
Fax | 512-284-7203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1033 LA POSADA DR SUITE 308
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78752-3842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-284-7192
-----------------------------------------------------
Fax | 512-284-7203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1141182
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------