MEDICARE: NICOLE GRAY 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	305394	KY

General Provider Information

NPI Number	:	1831027549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE GRAY LMT

Provider Business Mailing Address
First Line	:	2815 BARDSTOWN RD # 2
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 BARDSTOWN RD # 2
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2644
Country	:	US
Telephone Number	:	502-215-0225
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ NICOLE GRAY LMT” Practice Location

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