=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841416294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGREET A RAY RPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 12/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3699 WILSHIRE BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-2718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-783-1923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1525 VALLEY DR
-----------------------------------------------------
City | TOPANGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90290-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-455-2741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 14208
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------