Provider Demographics
NPI:1164623120
Name:BRAY, PATRICIA TIPTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:TIPTON
Last Name:BRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24037 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HOWEY IN THE HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34737-3924
Mailing Address - Country:US
Mailing Address - Phone:407-296-1901
Mailing Address - Fax:407-253-2515
Practice Address - Street 1:24037 PALM AVE
Practice Address - Street 2:
Practice Address - City:HOWEY IN THE HILLS
Practice Address - State:FL
Practice Address - Zip Code:34737-3924
Practice Address - Country:US
Practice Address - Phone:407-296-1000
Practice Address - Fax:407-253-2515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0004138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist