Healthcare Provider Details

I. General information

NPI: 1023922416
Provider Name (Legal Business Name): CARSON RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 KIMEL PARK DR
WINSTON SALEM NC
27103-6946
US

IV. Provider business mailing address

865 JOE ROAD
MOCKSVILLE NC
27028
US

V. Phone/Fax

Practice location:
  • Phone: 325-765-7058
  • Fax:
Mailing address:
  • Phone: 252-435-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA8656
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: