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General NPI Number Information
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NPI Number | 1467028282
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Entity Type | Individual
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Provider Name | MICHAEL L RAY PTA
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Gender | Male
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 4812 HAMBURG PIKE
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-9209
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Country | US
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Telephone | 812-282-4257
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Fax | 812-288-1161
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Provider Business Mailing Address
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Address Line | 9514 STONELANDING PL
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City | LOUISVILLE
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State | KY
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Zip | 40272-7201
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Country | US
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Telephone | 502-424-2151
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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 | A01317
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06001833A
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License Number State | IN
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