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General NPI Number Information
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NPI Number | 1790250827
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Entity Type | Individual
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Provider Name | RICHARD JAMES RAY PTA
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Gender | Male
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 530 THORNTON RD # 210
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-4120
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Country | US
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Telephone | 404-855-2141
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Fax |
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Provider Business Mailing Address
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Address Line | 811 JUNIPER ST NE APT 1520
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City | ATLANTA
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State | GA
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Zip | 30308-2162
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA004107
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License Number State | GA
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