Provider Demographics
NPI:1033595095
Name:MAGO, RAY JOHN (PT)
Entity Type:Individual
Prefix:
First Name:RAY JOHN
Middle Name:
Last Name:MAGO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 MEDAU PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2809
Mailing Address - Country:US
Mailing Address - Phone:510-339-2116
Mailing Address - Fax:
Practice Address - Street 1:6116 MEDAU PL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2809
Practice Address - Country:US
Practice Address - Phone:510-339-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist