Provider Demographics
NPI:1245598242
Name:RAY, ASHLEY (CO)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:KOONCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 MATLOCK RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2934
Mailing Address - Country:US
Mailing Address - Phone:817-467-9977
Mailing Address - Fax:517-465-1040
Practice Address - Street 1:3030 MATLOCK RD STE 108
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2934
Practice Address - Country:US
Practice Address - Phone:817-467-9977
Practice Address - Fax:517-465-1040
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1455222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist