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NPI Code Detail

MEDICARE: MORGAN GRAY ATC

MEDICARE: MORGAN GRAY ATC
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
12255A2300XAthletic Trainer2000022875VA

General Provider Information

NPI Number : 1982166864
Entity Type Code : Individual
Provider Name (Legal Business Name) : MORGAN GRAY ATC
Provider Business Mailing Address
First Line : 4365 STARKEY RD
Second Line :
City : ROANOKE
State : VA
Zip : 24018-0610
Country : US
Telephone Number : 540-527-5068
Fax Number : 540-527-5093
Provider Business Practice Location Address
First Line : 4365 STARKEY RD
Second Line :
City : ROANOKE
State : VA
Zip : 24018-0610
Country : US
Telephone Number : 540-527-5068
Fax Number : 540-527-5093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2019
Last Update Date : 10/03/2025

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