Healthcare Provider Details

I. General information

NPI: 1013552389
Provider Name (Legal Business Name): KARLA ELISE MCCRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S SEMORAN BLVD STE 110A
WINTER PARK FL
32792-5313
US

IV. Provider business mailing address

4020 MISTY MORNING PL
CASSELBERRY FL
32707-5290
US

V. Phone/Fax

Practice location:
  • Phone: 407-432-5260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA27672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: