Provider Demographics
NPI:1124711841
Name:GRAY, KELSIE J (DPT)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:J
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7816
Mailing Address - Country:US
Mailing Address - Phone:406-449-0654
Mailing Address - Fax:406-449-0516
Practice Address - Street 1:3336 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7816
Practice Address - Country:US
Practice Address - Phone:406-449-0654
Practice Address - Fax:406-449-0516
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT27066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist