Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 4129 | AR |
NPI | 1013460179 |
---|---|
Provider Name | Laura Beth Ray |
First Address | Wynne, AR 72396-8506 |
Second Address | Wynne, AR 72396-8506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 25/07/2016 |