Provider Demographics
NPI:1275528424
Name:RAYCE, VALERIE L (PTA, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:L
Last Name:RAYCE
Suffix:
Gender:F
Credentials:PTA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 E COUNTY ROAD 700 S
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-8096
Mailing Address - Country:US
Mailing Address - Phone:765-526-6328
Mailing Address - Fax:
Practice Address - Street 1:1780 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-8722
Practice Address - Country:US
Practice Address - Phone:765-653-3610
Practice Address - Fax:765-653-3610
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001751A225200000X
IN36000339A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN06001751AOtherPTA LICENSE
IN36000339AOtherATC LICENSE (STATE)