Provider Demographics
NPI:1578696167
Name:MCCRAY, GERALDINE W (PT)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:W
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1014 S WESTLAKE BLVD
Mailing Address - Street 2:STE. #14
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3108
Mailing Address - Country:US
Mailing Address - Phone:818-991-8458
Mailing Address - Fax:818-707-6455
Practice Address - Street 1:1014 S WESTLAKE BLVD
Practice Address - Street 2:STE. #14
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3108
Practice Address - Country:US
Practice Address - Phone:818-991-8458
Practice Address - Fax:818-707-6455
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT02166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist