Individual
BENJAMIN GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3540 KIOWA BLVD S, LAKE HAVASU CITY, AZ 86404-3428
(928) 551-5590
Mailing address
3540 KIOWA BLVD S, LAKE HAVASU CITY, AZ 86404-3428
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
10504A
AZ
Other
Enumeration date
09/10/2014
Last updated
09/10/2014
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