Provider Demographics
NPI:1154083053
Name:DRAY, VINCENT D (DPT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:D
Last Name:DRAY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2400
Mailing Address - Country:US
Mailing Address - Phone:414-541-1118
Mailing Address - Fax:414-541-3066
Practice Address - Street 1:8800 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2400
Practice Address - Country:US
Practice Address - Phone:414-541-1118
Practice Address - Fax:414-541-3066
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15412-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15615OtherLICENSE NUMBER