Individual
MRS. SHANNA RAE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
4010 BLAINE RD, SHAWNEE, OK 74804-1626
(405) 833-2749
Mailing address
4010 BLAINE RD, SHAWNEE, OK 74804-1626
(405) 833-2749
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT1801
OK
Other
Enumeration date
07/09/2007
Last updated
07/09/2007
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