Provider Demographics
NPI:1871157073
Name:GRAY, JANIKA E (PT, DPT)
Entity type:Individual
Prefix:
First Name:JANIKA
Middle Name:E
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3867 BAYOU ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-9232
Mailing Address - Country:US
Mailing Address - Phone:318-283-2080
Mailing Address - Fax:318-283-0606
Practice Address - Street 1:3867 BAYOU ACRES DR
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-9232
Practice Address - Country:US
Practice Address - Phone:318-283-2080
Practice Address - Fax:318-283-0606
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist