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General NPI Number Information
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NPI Number | 1366250136
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Entity Type | Individual
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Provider Name | KIMMY-ANN WRAY
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Gender | Female
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Dates
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Enumeration Date | 12/24/2024
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 6515 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-4008
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Country | US
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Telephone | 786-334-3125
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Fax |
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Provider Business Mailing Address
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Address Line | 11031 SW 25TH ST APT 1310
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City | MIRAMAR
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State | FL
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Zip | 33025-7680
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Country | US
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Telephone | 954-851-6134
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 33609
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License Number State | FL
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