Provider Demographics
NPI:1154754109
Name:GRAY, AARON M (DPT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:M
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 1:810 MAYFIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3046
Mailing Address - Country:US
Mailing Address - Phone:770-205-3939
Mailing Address - Fax:770-205-4994
Practice Address - Street 1:810 MAYFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30009-3046
Practice Address - Country:US
Practice Address - Phone:770-205-3939
Practice Address - Fax:770-205-4994
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011170225100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist