=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174827778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA KRAY PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2010
-----------------------------------------------------
Last Update Date | 12/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11110 OHIO AVE STE 206
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-6349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-444-8812
-----------------------------------------------------
Fax | 310-444-8813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 83694
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90083-0694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-908-9226
-----------------------------------------------------
Fax | 310-444-8813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | PT13481
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------