Individual
JESSICA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
103 S PIONEER RD, SUITE #100, FOND DU LAC, WI 54935-3800
(920) 922-7776
(920) 922-2938
Mailing address
103 S PIONEER RD, SUITE #100, FOND DU LAC, WI 54935-3800
(920) 922-7776
(920) 922-2938
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1836-19
WI
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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