Sydelle Marra Gray, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2021006177 Issued in MO

Practice address

12608 Lamplighter Square Shopping Center
Saint Louis, MO 63128

Phone

(314) 842-4222

NPI assigned

Mar 10, 2021

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

• Sydelle Marra Tockman Former name

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Missouri Physical Therapy LLCGroup PAC ID 6901870187, 59 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Central Missouri Physical Therapy LLC

  dba Peak Sport and Spine

  • Physical Therapist
  • Columbia, MO
  • NPI 1558436592
  Medicare reassignment Care Compare group NPD
• Elite Physical Therapy LLC

  dba CORA Physical Therapy - South County

  • Rehabilitation Clinic/Center
  • Saint Louis, MO
  • NPI 1760736185

  Physical Therapist

  NPD

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

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1538744750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 AUTUMN VIEW CT",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633767343",
            "telephone_number": "636-485-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12608 LAMPLIGHTER SQUARE SHOPPING CENTER",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-842-4222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "SYDELLE",
        "middle_name": "MARRA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-03-10",
        "certification_date": "2021-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2021006177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SYDELLE",
            "last_name": "TOCKMAN",
            "middle_name": "MARRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mellaney Gray, SLP M.S.
• Natalie Gray
• O. Danel Louis Gray, MSW, LCSW, DCSW
• Ragina Gray
• Robert E Gray, PA-C
• William Allen Gray, D.M.D. MD
• Alexander E Graypel, M.D.
• Ernest Alexander Graypel, MD
• Karen Grayson, LPC
• Great Circle

• Physical Therapist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.