Provider Demographics
NPI:1467028282
Name:RAY, MICHAEL L (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:RAY
Suffix:
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 1:9514 STONELANDING PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-7201
Mailing Address - Country:US
Mailing Address - Phone:502-424-2151
Mailing Address - Fax:
Practice Address - Street 1:4812 HAMBURG PIKE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-9209
Practice Address - Country:US
Practice Address - Phone:812-282-4257
Practice Address - Fax:812-288-1161
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01317225200000X
IN06001833A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant