Provider Demographics
NPI:1073291878
Name:GRAY PERFORMANCE THERAPY
Entity type:Organization
Organization Name:GRAY PERFORMANCE THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVON
Authorized Official - Middle Name:HUSTON
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:614-204-6731
Mailing Address - Street 1:433 PARK OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3661
Mailing Address - Country:US
Mailing Address - Phone:614-204-6731
Mailing Address - Fax:614-681-0353
Practice Address - Street 1:2398 WOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3520
Practice Address - Country:US
Practice Address - Phone:614-204-6731
Practice Address - Fax:614-681-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy