MEDICARE: BENJAMIN DAVID RAY DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1285158790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN DAVID RAY DPT

Provider Business Mailing Address
First Line	:	802 E MAIN ST
Second Line	:
City	:	MANNINGTON
State	:	WV
Zip	:	26582-1215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 E MAIN ST
Second Line	:
City	:	MANNINGTON
State	:	WV
Zip	:	26582-1215
Country	:	US
Telephone Number	:	304-986-9007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	07/27/2017

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