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NPI Code Detail

MEDICARE: MRS. SARAH JEAN WRAY PTA

MEDICARE: MRS. SARAH JEAN WRAY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant514-19WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417120924
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARAH JEAN WRAY PTA
Provider Business Mailing Address
First Line : 2961 SAINT ANTHONY DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-5860
Country : US
Telephone Number : 920-983-9298
Fax Number : 920-468-3087
Provider Business Practice Location Address
First Line : 2961 SAINT ANTHONY DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-5860
Country : US
Telephone Number : 920-468-0861
Fax Number : 920-468-3087
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2008
Last Update Date : 09/11/2012

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