Basic Information
| Provider Information | |||||||||
| NPI: | 1760597181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 HALL DR | ||||||||
| Address2: | AMHERST MEDICAL CENTER | ||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010022751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132564415 | ||||||||
| FaxNumber: | 4132564490 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 HALL DR | ||||||||
| Address2: | AMHERST MEDICAL CENTER | ||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010022751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132564415 | ||||||||
| FaxNumber: | 4132564490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 01/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4730 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Y67942 | 01 | BLUE CROSS | OTHER | 650017524 | 01 | RAILROAD MEDICARE | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 0394742 | 01 | MEDICAID WELFARE | OTHER | 0394742 | 05 | MA | MEDICAID | 115682 | 01 | FALLON COMMUNITY HEALTH P | OTHER |