Provider Demographics
NPI:1225510415
Name:RAY, DEREK ANDREW (DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:ANDREW
Last Name:RAY
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 1:500 MUSGRAVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-2700
Mailing Address - Country:US
Mailing Address - Phone:870-845-5600
Mailing Address - Fax:870-845-5605
Practice Address - Street 1:3030 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5325
Practice Address - Country:US
Practice Address - Phone:870-246-8623
Practice Address - Fax:870-246-8694
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist