Organization
GARY GRAY PHYSICAL THERAPY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDOLPH P FRIESER PT (PRESIDENT/SECRETARY)
(312) 640-0329
Entity
Organization
Contact information
Practice address
1801 W MAUMEE ST, SUITE 125, ADRIAN, MI 49221-1291
(517) 264-6141
(517) 263-5786
Mailing address
205 W WACKER DR, SUITE 1020, CHICAGO, IL 60606-1216
(312) 640-0329
(312) 640-0407
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
MI
225X00000X
Occupational Therapist
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-6636
MEDICARE ID
MI
Enumeration date
08/08/2007
Last updated
02/24/2010
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