Provider Demographics
NPI:1225188550
Name:WRAY, CHARLES LESTER
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LESTER
Last Name:WRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-3749
Mailing Address - Country:US
Mailing Address - Phone:501-623-7421
Mailing Address - Fax:501-620-7847
Practice Address - Street 1:400 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-3749
Practice Address - Country:US
Practice Address - Phone:501-623-7421
Practice Address - Fax:501-620-7847
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist