Provider Demographics
NPI:1992293039
Name:GRAY, HALEY (ATC)
Entity type:Individual
Prefix:MISS
First Name:HALEY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 CRADDOCK AVE APT 1624C
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-1190
Mailing Address - Country:US
Mailing Address - Phone:901-268-2886
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4684
Practice Address - Country:US
Practice Address - Phone:901-268-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT71472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherN/A