Provider Demographics
NPI:1124270830
Name:GRAY, DANA LYN (RMT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYN
Last Name:GRAY
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYN
Other - Last Name:YAUCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RMT
Mailing Address - Street 1:P.O. BOX 82
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959
Mailing Address - Country:US
Mailing Address - Phone:608-524-7707
Mailing Address - Fax:
Practice Address - Street 1:350 N. DEWEY AVE.
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959
Practice Address - Country:US
Practice Address - Phone:608-524-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI109-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist