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General NPI Number Information
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NPI Number | 1700074994
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Entity Type | Organization
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Legal Business Name | PAUL E GRAY
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 1711 ASHLEY CIR SUITE 4
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5801
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Country | US
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Telephone | 270-842-1690
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Fax | 270-842-2163
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Provider Business Mailing Address
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Address Line | 1711 ASHLEY CIR SUITE 4
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5801
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Country | US
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Telephone | 270-842-1690
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Fax | 270-842-2163
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | PAUL E GRAY
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Credential | P.T.
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Telephone | 270-842-1690
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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 | 000555
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License Number State | KY
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