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General NPI Number Information
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NPI Number | 1497681076
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Entity Type | Individual
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Provider Name | NOAH RAY PTA
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Gender | Male
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 2741 CARIBBEAN ISLE BLVD APT 2506
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City | MELBOURNE
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State | FL
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Zip | 32935-8006
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Country | US
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Telephone | 912-678-2807
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Fax |
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Provider Business Mailing Address
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Address Line | 6141 LAKE WORTH RD
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City | GREENACRES
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State | FL
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Zip | 33463-3074
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Country | US
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Telephone | 912-678-2807
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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 | 34646
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License Number State | FL
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