MEDICARE: TEDD GRAY DPT, LMT

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	225700000X	Massage Therapist	11797529-4701	UT
2	225100000X	Physical Therapist	11797529-2401	UT

General Provider Information

NPI Number	:	1649861071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEDD GRAY DPT, LMT

Provider Business Mailing Address
First Line	:	4285 S HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4285 S HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2603
Country	:	US
Telephone Number	:	801-278-2839
Fax Number	:

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

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	12/02/2025

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