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NPI Code Detail

MEDICARE: TERESA CARLA RAY PT

MEDICARE: TERESA CARLA RAY PT
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
1225100000XPhysical Therapist1147015TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18T8073OTHERTXBLUE CROSS BLUE SHIELD
21147015OTHERTXP.T. LICENSE

General Provider Information

NPI Number : 1598832297
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA CARLA RAY PT
Provider Business Mailing Address
First Line : 1301 E HOUSTON ST
Second Line :
City : BEEVILLE
State : TX
Zip : 78102-5309
Country : US
Telephone Number : 361-362-1700
Fax Number :
Provider Business Practice Location Address
First Line : 1301 E HOUSTON ST
Second Line :
City : BEEVILLE
State : TX
Zip : 78102-5309
Country : US
Telephone Number : 361-362-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 05/10/2008

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Directions to “ TERESA CARLA RAY PT” Practice Location

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