Provider Demographics
NPI:1326212309
Name:MCCRAY, EDWIN ASHLEY (PTA)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:ASHLEY
Last Name:MCCRAY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16824 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2874
Mailing Address - Country:US
Mailing Address - Phone:352-472-6601
Mailing Address - Fax:352-472-6601
Practice Address - Street 1:16824 NW 32ND AVE
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2874
Practice Address - Country:US
Practice Address - Phone:352-472-6601
Practice Address - Fax:352-472-6601
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1905225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant