Provider Demographics
NPI:1437371937
Name:RAY, CARRIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S CARAWAY RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7304
Mailing Address - Country:US
Mailing Address - Phone:870-933-2055
Mailing Address - Fax:870-910-0245
Practice Address - Street 1:2701 S CARAWAY RD
Practice Address - Street 2:SUITE B2
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7304
Practice Address - Country:US
Practice Address - Phone:870-933-2055
Practice Address - Fax:870-910-0245
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1772174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist