Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 01633 | MO |
NPI | 1487281804 |
---|---|
Provider Name | Teresa Gray |
First Address | Springfield, MO 65802-9287 |
Second Address | Springfield, MO 65807-7310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2020 |
Last Update Date | 25/03/2020 |