Provider Demographics
NPI:1841419629
Name:GRAY, BRANDON D (MPT, DPT)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:D
Last Name:GRAY
Suffix:
Gender:M
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 FM 1960 RD W
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3827
Mailing Address - Country:US
Mailing Address - Phone:281-469-8163
Mailing Address - Fax:281-469-5559
Practice Address - Street 1:11811 FM 1960 RD W
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3827
Practice Address - Country:US
Practice Address - Phone:281-469-8163
Practice Address - Fax:281-469-5559
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1147810225100000X
TN6697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12407992OtherMULTIPLAN
TX8T3135OtherBLUE CROSS BLUE SHIELD
TX8T6003OtherBLUE CROSS BLUE SHIELD
TX0042RLOtherBLUE CROSS BLUE SHIELD
TX00Z751Medicare PIN
TX0042RLOtherBLUE CROSS BLUE SHIELD