Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO02178 | VA |
NPI | 1558641258 |
---|---|
Provider Name | Mr. James Michael Ray |
First Address | Virginia Beach, VA 23452 |
Second Address | Virginia Beach, VA 23452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 07/08/2018 |