Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT60955427 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | 21768 | MA |
NPI | 1013316868 |
---|---|
Provider Name | Conor D. Bray |
First Address | Seattle, WA 98102-3086 |
Second Address | Seattle, WA 98102-3086 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 08/06/2020 |