Provider Demographics
NPI:1689947988
Name:WRAY, CAROLYN EISH (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:EISH
Last Name:WRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BEN CASEY DR
Mailing Address - Street 2:STE 127
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8557
Mailing Address - Country:US
Mailing Address - Phone:803-802-5855
Mailing Address - Fax:803-636-8078
Practice Address - Street 1:706 SUMMIT CROSSING PL
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2175
Practice Address - Country:US
Practice Address - Phone:704-323-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5640225100000X
NCP2412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ39030AMedicare PIN
NC0002312769Medicare NSC