Provider Demographics
NPI:1124609268
Name:GRAY, MARISSA MARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 MAGNOLIA PKWY STE G
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1649
Mailing Address - Country:US
Mailing Address - Phone:281-213-0642
Mailing Address - Fax:
Practice Address - Street 1:11540 MAGNOLIA PKWY STE G
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1649
Practice Address - Country:US
Practice Address - Phone:281-213-0642
Practice Address - Fax:281-213-0324
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty