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General NPI Number Information
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NPI Number | 1710120563
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Entity Type | Organization
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Legal Business Name | WRAYCON, LLC
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 4505 MARTINWOOD DR
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City | HAYMARKET
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State | VA
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Zip | 20169-2208
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Country | US
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Telephone | 703-470-1391
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 285
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City | HAYMARKET
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State | VA
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Zip | 20168-0285
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Country | US
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Telephone | 703-470-1391
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLYDE WILLIAM WRAY
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Credential |
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Telephone | 703-470-1391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 2705117776
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number | 2705117776
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 2705117776
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License Number State | VA
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