Provider Demographics
NPI:1124707971
Name:GRAY, TIMOTHY (DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 26TH AVE E APT 307
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5472
Mailing Address - Country:US
Mailing Address - Phone:313-401-4340
Mailing Address - Fax:
Practice Address - Street 1:9107 FORTUNA DR
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3132
Practice Address - Country:US
Practice Address - Phone:206-209-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist