Daniel Gray

Individual provider Active NPI Physical Therapy Assistant · York, SC

NPI 1265091086 · NPPES record last updated Jun 10, 2019

Key facts

NPI
1265091086
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
4141 (SC)
Practice address
1528 Autumn Brook LN
York, SC 29745-5316
Phone
(803) 628-8114
NPI assigned
Jun 6, 2019
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
4141SCMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 4141 SC Yes

Addresses

Primary practice location

1528 Autumn Brook LN
York, SC 29745-5316

Mailing address

1528 Autumn Brook LN
York, SC 29745-5316

Other providers in York, SC

All providers in York, SC · Physical Therapy Assistant in South Carolina

Sources for this page

Verify at the official NPI Registry.