Provider Demographics
NPI:1366492340
Name:RAY, LAURIE (MPT)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 STEARMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROUGEMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27572-8017
Mailing Address - Country:US
Mailing Address - Phone:919-636-1827
Mailing Address - Fax:
Practice Address - Street 1:6303 STEARMAN RD
Practice Address - Street 2:
Practice Address - City:ROUGEMONT
Practice Address - State:NC
Practice Address - Zip Code:27572-8017
Practice Address - Country:US
Practice Address - Phone:919-636-1827
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79352251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211001Medicaid