Provider Demographics
NPI:1962952010
Name:GRAY, CAROL (PHYSIOLOGST,HCOACH)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHYSIOLOGST,HCOACH
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:GRAY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPT,CWHC IN PROGRESS
Mailing Address - Street 1:6687 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HURDLE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27541-9319
Mailing Address - Country:US
Mailing Address - Phone:336-747-0528
Mailing Address - Fax:
Practice Address - Street 1:910 N MADISON BLVD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4573
Practice Address - Country:US
Practice Address - Phone:336-322-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Provider Identifiers
StateIdentifier IDID TypeIssuer
T49071OtherAMERICAN COUNCIL ON EXERCISE
NCBS DEGREEOtherAPPALCHIAN STATE UNIVERSITY
NC14488787OtherAMERICAN RED CROSS