Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 6369 | TX |
NPI | 1407077985 |
---|---|
Provider Name | Dr. Selena Paige Gray |
First Address | San Antonio, TX 78251-1476 |
Second Address | San Antonio, TX 78251-1476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/12/2009 |