Provider Demographics
NPI:1992425284
Name:GRAY, AMANDA BROOKE (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MCFARLAND BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3371
Mailing Address - Country:US
Mailing Address - Phone:205-333-5351
Mailing Address - Fax:205-333-5345
Practice Address - Street 1:400 MCFARLAND BLVD STE F
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3371
Practice Address - Country:US
Practice Address - Phone:205-333-5351
Practice Address - Fax:205-333-5345
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist