Provider Demographics
NPI:1417163866
Name:YBANEZ, RAY SY (DPT)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:SY
Last Name:YBANEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-5910
Mailing Address - Country:US
Mailing Address - Phone:561-742-3345
Mailing Address - Fax:561-742-8933
Practice Address - Street 1:2015 OCEAN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5131
Practice Address - Country:US
Practice Address - Phone:561-742-3345
Practice Address - Fax:561-742-8933
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3544Medicare PIN