MEDICARE: KEVON GRAY PT, DPT

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	225100000X	Physical Therapist	PT017232	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205490927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVON GRAY PT, DPT

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

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	09/07/2023

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Directions to “ KEVON GRAY PT, DPT” Practice Location

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