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General NPI Number Information
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NPI Number | 1376009795
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Entity Type | Individual
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Provider Name | BRAY JACKSON DPT
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Gender | Male
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 312 SLEEPY HOLLOW DR
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City | MECHANICSBURG
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State | PA
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Zip | 17055-6075
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Country | US
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Telephone | 724-833-8258
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Fax |
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Provider Business Mailing Address
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Address Line | 715 GRINNAGE RUN RD
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City | WAYNESBURG
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State | PA
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Zip | 15370-3826
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT030626
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License Number State | PA
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