Provider Demographics
NPI:1225009277
Name:BRAY, JOAN (DPT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:TAYLOR-WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TAYLOR-WEBB
Mailing Address - Street 1:5015 PIERHEAD COURT
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8165
Mailing Address - Country:US
Mailing Address - Phone:919-995-0255
Mailing Address - Fax:
Practice Address - Street 1:4330 SOUTHPORT SUPPLY RD SE STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-9265
Practice Address - Country:US
Practice Address - Phone:910-363-4222
Practice Address - Fax:910-477-6336
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2149174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC720795RMedicaid
NC250-3962AMedicare ID - Type Unspecified