MEDICARE: GRAY PERFORMANCE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1073291878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAY PERFORMANCE THERAPY

Provider Business Mailing Address
First Line	:	433 PARK OVERLOOK DR
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-3661
Country	:	US
Telephone Number	:	614-204-6731
Fax Number	:	614-681-0353

Provider Business Practice Location Address
First Line	:	2398 WOOD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-3520
Country	:	US
Telephone Number	:	614-204-6731
Fax Number	:	614-681-0353

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	DR. KEVON HUSTON GRAY
Credential	:	DPT
Telephone Number	:	614-204-6731

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	09/07/2023

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Directions to “GRAY PERFORMANCE THERAPY ” Practice Location

Language	Start Address	Practice Location

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