MEDICARE: BETHANY 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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1952843799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY GRAY

Provider Business Mailing Address
First Line	:	251 JOHNSTON ST SE
Second Line	:	SUITE 300
City	:	DECATUR
State	:	AL
Zip	:	35601-2515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 MILITARY ST S
Second Line	:
City	:	HAMILTON
State	:	AL
Zip	:	35570-5004
Country	:	US
Telephone Number	:	256-340-1764
Fax Number	:

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

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	02/03/2020

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Directions to “ BETHANY GRAY ” Practice Location

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