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NPI Code Detail

MEDICARE: JAMES WRAY P.T.

MEDICARE:   JAMES  WRAY  P.T.
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
1174400000XSpecialist40QA006934000NJ
2225100000XPhysical Therapist34697CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1650022786OTHERNJRR MDCR #
2800062078OTHERCATAX ID
3223596388OTHERNJTAX IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1942203328
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES WRAY P.T.
Provider Business Mailing Address
First Line : 3639 MIDWAY DR STE B286
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-5254
Country : US
Telephone Number : 858-488-3597
Fax Number : 858-746-4041
Provider Business Practice Location Address
First Line : 3115 OCEAN FRONT WALK
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-8729
Country : US
Telephone Number : 858-488-3597
Fax Number : 858-746-4041
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 03/25/2010

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