Provider Demographics
NPI:1194786178
Name:GRAY, LAURA LINDSAY (DPT MBA MED CERT MDT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LINDSAY
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPT MBA MED CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ENTERPRISE PKWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6249
Mailing Address - Country:US
Mailing Address - Phone:757-827-2481
Mailing Address - Fax:757-827-2566
Practice Address - Street 1:901 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6249
Practice Address - Country:US
Practice Address - Phone:757-827-2481
Practice Address - Fax:757-827-2566
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954Medicare PIN
VA650000219Medicare PIN
VA192951OtherBCBS PHYSICAL THERAPY
VA650015626OtherMEDICARE RAILROAD
VAC05954Medicare PIN
VA8928541Medicaid