Organization
III GEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS WILL GRAY III DPT (OWNER)
(662) 352-9386
Entity
Organization
Contact information
Practice address
402 CYNTHIA ST STE E, CLINTON, MS 39056-3753
(601) 460-1693
(866) 467-3612
Mailing address
PO BOX 1063, CLINTON, MS 39060-1063
(662) 352-9386
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114405263
—
MS
Enumeration date
01/12/2023
Last updated
01/12/2023
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