Provider Demographics
NPI:1417588062
Name:MURRAY, AVA MARIE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:MARIE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:MARIE
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:282 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2727
Mailing Address - Country:US
Mailing Address - Phone:607-729-9206
Mailing Address - Fax:
Practice Address - Street 1:282 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2727
Practice Address - Country:US
Practice Address - Phone:607-729-9206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043340-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist