Provider Demographics
NPI:1346786563
Name:WRAY, CRYSTAL (DPT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 FIELDSTOWN RD
Mailing Address - Street 2:SUITE # 116
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-3414
Mailing Address - Country:US
Mailing Address - Phone:256-531-4567
Mailing Address - Fax:
Practice Address - Street 1:592 FIELDSTOWN RD
Practice Address - Street 2:SUITE # 116
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-3414
Practice Address - Country:US
Practice Address - Phone:256-531-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist