Angela Beth Gray, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1804 Issued in AR

Practice address

17706 Interstate 30 N
Benton, AR 72019-2907

Phone

(501) 315-4414

NPI assigned

Apr 27, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Angela Beth Gray Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reach Behavioral Health

  • Clinical Social Worker
  • Benton, AR
  • NPI 1093379935
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1477510105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17706 INTERSTATE 30 N",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720192907",
            "telephone_number": "501-315-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17706 INTERSTATE 30 N",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720192907",
            "telephone_number": "501-315-4414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10301 Kanis Rd",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722056205",
            "country_code": "US",
            "telephone_number": "501-604-4170",
            "fax_number": "501-604-3223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "ANGELA",
        "middle_name": "BETH",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "PTA1804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "GRAY",
            "middle_name": "BETH",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Clarissa Grant, CMP
• Jonha-Virginia Grant
• Nancy Dorothy Grant, L.P.C.
• Anna Claire Graves
• Irving Graves, RECOVERY ASSISTANT
• Courtney Gray
• Daffiny Gray
• Tesla Gray
• Sandy Grayson, LPE
• Holly Grebert

• Physical Therapy Assistant in Benton, AR
• Providers in Benton, AR by specialty
• Physical Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.