Shelly L. Gray, PTA
Individual provider Active NPI Physical Therapy Assistant · Kirksville, MO
NPI 1184850307 · NPPES record last updated Jun 2, 2009
Key facts
- NPI
- 1184850307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2006023686 (MO)
- Practice address
- 2814 S Baltimore St
Kirksville, MO 63501-4640 - Phone
- (660) 785-1834
- Fax
- (660) 785-1825
- NPI assigned
- Jun 2, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006023686 | MO | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kirksville Physical Therapy Services LLC | Past |
Accepting new patients | |
| Kirksville Missouri Hospital Company, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2006023686 | MO | Yes |
Addresses
Primary practice location
2814 S Baltimore St
Kirksville, MO 63501-4640
Mailing address
PO Box C8502
Kirksville, MO 63501-8599
Phone (660) 785-1834
Other providers in Kirksville, MO
- Tara Gordon
- Kajal Govin
- John Warren Goza
- Sue Granger
- Kerena Areli Gray
- Connor Joseph Greaves
- Melanie S. Grgurich
- Ashlie Renee Griffith
- Kailey B Grinder
- Christy L Grissom
All providers in Kirksville, MO · Physical Therapy Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.