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General NPI Number Information
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NPI Number | 1225009277
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Entity Type | Individual
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Provider Name | JOAN BRAY DPT
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Gender | Female
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Dates
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Enumeration Date | 01/29/2006
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 4330 SOUTHPORT SUPPLY RD SE STE 103
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City | SOUTHPORT
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State | NC
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Zip | 28461-9265
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Country | US
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Telephone | 910-363-4222
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Fax | 910-477-6336
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Provider Business Mailing Address
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Address Line | 5015 PIERHEAD COURT
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City | SOUTHPORT
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State | NC
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Zip | 28461-8165
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Country | US
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Telephone | 919-995-0255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2149
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2149
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License Number State | NC
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