Provider Demographics
NPI:1043817612
Name:BRAY, KEVIN J (LMT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:BRAY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:J
Other - Last Name:BRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2434 LANDOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-3331
Mailing Address - Country:US
Mailing Address - Phone:352-398-8041
Mailing Address - Fax:
Practice Address - Street 1:2434 LANDOVER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3331
Practice Address - Country:US
Practice Address - Phone:352-398-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA14700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist