Provider Demographics
NPI:1235543026
Name:RAY, RICK (AT,C)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:INSTITUTE
Mailing Address - State:WV
Mailing Address - Zip Code:25112-1000
Mailing Address - Country:US
Mailing Address - Phone:304-766-3225
Mailing Address - Fax:304-766-3364
Practice Address - Street 1:5000 FAIRLAWN AVE.
Practice Address - Street 2:
Practice Address - City:INSTITUTE
Practice Address - State:WV
Practice Address - Zip Code:25112-1000
Practice Address - Country:US
Practice Address - Phone:304-766-3225
Practice Address - Fax:304-766-3364
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0011952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer