Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 010740-1 | NY |
NPI | 1093941825 |
---|---|
Provider Name | Kathryn Yates Gray |
First Address | Roosevelt, NY 11575-1845 |
Second Address | Roosevelt, NY 11575-1845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 08/06/2009 |