Provider Demographics
NPI:1306835251
Name:RAY, BETH RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:RENEE
Last Name:RAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:RENEE
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:398 OLYMPIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-233-1080
Mailing Address - Fax:865-233-1081
Practice Address - Street 1:398 OLYMPIA DRIVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-233-1080
Practice Address - Fax:865-233-1081
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4011OtherSTAYWELL
FL27001OtherWELLCARE PROVIDER
FL2288818OtherAETNA PROVIDER NUMBER
FLY909JOtherBCBS PROVIDER NUMBER
FL27001OtherWELLCARE PROVIDER
FLK3420Medicare ID - Type UnspecifiedMCR GROUP PROVIDER ID