Healthcare Provider Details

I. General information

NPI: 1699058289
Provider Name (Legal Business Name): MELINDA BLAINE WRAY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9818 HWY 62 W
VIOLA AR
72583
US

IV. Provider business mailing address

137 SHADY OAKS LN
VIOLA AR
72583-9130
US

V. Phone/Fax

Practice location:
  • Phone: 870-321-4457
  • Fax:
Mailing address:
  • Phone: 870-321-4457
  • Fax: 870-895-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3421
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: