MEDICARE: KRISTEN L 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	7501015654	MI

General Provider Information

NPI Number	:	1992688352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN L GRAY LMT

Provider Business Mailing Address
First Line	:	35526 YOUNG DR
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-2391
Country	:	US
Telephone Number	:	586-822-6270
Fax Number	:

Provider Business Practice Location Address
First Line	:	19193 15 MILE RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-2508
Country	:	US
Telephone Number	:	586-770-4002
Fax Number	:

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

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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