Provider Demographics
NPI:1053458968
Name:WRAY, HEATHER E (PT)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:E
Last Name:WRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:W
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:107 CHESAPEAKE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921
Mailing Address - Country:US
Mailing Address - Phone:410-392-9400
Mailing Address - Fax:410-392-0577
Practice Address - Street 1:107 CHESAPEAKE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-392-9400
Practice Address - Fax:410-392-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist