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General NPI Number Information
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NPI Number | 1518298553
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Entity Type | Individual
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Provider Name | BRITNEY BUCK GRAY
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Gender | Female
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 3728 PHILLIPS HWY SUITE 215A
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City | JACKSONVILLE
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State | FL
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Zip | 32207-9300
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Country | US
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Telephone | 904-398-0280
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8847
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City | FLEMING ISLAND
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State | FL
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Zip | 32006-0019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT22496
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License Number State | ZZ
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