Provider Demographics
NPI:1326919689
Name:GRAY, KAITLYN (PTA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E BETHANY HOME RD STE A125
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1289
Mailing Address - Country:US
Mailing Address - Phone:602-497-2109
Mailing Address - Fax:602-492-9992
Practice Address - Street 1:301 E BETHANY HOME RD STE A125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1289
Practice Address - Country:US
Practice Address - Phone:602-497-2109
Practice Address - Fax:602-492-9992
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-015016225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant