Provider Demographics
NPI:1316796501
Name:REAVES, GRAYSON
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:
Last Name:REAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FERRY DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9218
Mailing Address - Country:US
Mailing Address - Phone:601-559-5540
Mailing Address - Fax:
Practice Address - Street 1:742 K ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3331
Practice Address - Country:US
Practice Address - Phone:907-929-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist