MEDICARE: TERESA CARLA RAY PT

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	1147015	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T8073	OTHER	TX	BLUE CROSS BLUE SHIELD
2	1147015	OTHER	TX	P.T. LICENSE

General Provider Information

NPI Number	:	1598832297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA CARLA RAY PT

Provider Business Mailing Address
First Line	:	1301 E HOUSTON ST
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5309
Country	:	US
Telephone Number	:	361-362-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 E HOUSTON ST
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5309
Country	:	US
Telephone Number	:	361-362-1700
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	05/10/2008

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Directions to “ TERESA CARLA RAY PT” Practice Location

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