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NPI Code Detail

MEDICARE: DALTON MICHAEL GRAY

MEDICARE:   DALTON MICHAEL GRAY
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
1225200000XPhysical Therapy Assistant002914WV

General Provider Information

NPI Number : 1497437065
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALTON MICHAEL GRAY
Provider Business Mailing Address
First Line : 6741 COUNTRY CLUB DR
Second Line :
City : HUNTINGTON
State : WV
Zip : 25705-2051
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1390 N POPLAR FORK RD
Second Line :
City : HURRICANE
State : WV
Zip : 25526-7112
Country : US
Telephone Number : 304-757-7826
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2023
Last Update Date : 08/03/2023

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Directions to “ DALTON MICHAEL GRAY ” Practice Location

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