Provider Demographics
NPI:1386867307
Name:PLUMLEY, RAYMOND LEE JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:LEE
Last Name:PLUMLEY
Suffix:JR
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:P.O. BOX409
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-0409
Mailing Address - Country:US
Mailing Address - Phone:304-731-4134
Mailing Address - Fax:
Practice Address - Street 1:RT 92
Practice Address - Street 2:BOX 249
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-0249
Practice Address - Country:US
Practice Address - Phone:304-536-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001286225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant