=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003192089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAY PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2011
-----------------------------------------------------
Last Update Date | 10/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 388 W TULIP TREE AVE
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92865-1091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-906-8399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 388 W TULIP TREE AVE
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92865-1091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-906-8399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RAY ALEXIUS PANINSORO SATINA
-----------------------------------------------------
Credential | R.P.T.
-----------------------------------------------------
Telephone | 714-906-8399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------