MEDICARE: MS. MOLLY ELIZABETH 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	60038	OR
2	225100000X	Physical Therapist	3400	ID

General Provider Information

NPI Number	:	1457605040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MOLLY ELIZABETH GRAY PT, DPT

Provider Business Mailing Address
First Line	:	2906 W HILL RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-4706
Country	:	US
Telephone Number	:	541-255-5001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 W HILL RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-4706
Country	:	US
Telephone Number	:	541-255-5001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2012
Last Update Date	:	07/28/2025

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