Provider Demographics
NPI:1942203328
Name:WRAY, JAMES (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WRAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 MIDWAY DR STE B286
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5254
Mailing Address - Country:US
Mailing Address - Phone:858-488-3597
Mailing Address - Fax:858-746-4041
Practice Address - Street 1:3115 OCEAN FRONT WALK
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-8729
Practice Address - Country:US
Practice Address - Phone:858-488-3597
Practice Address - Fax:858-746-4041
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA006934000174400000X
CA34697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ650022786OtherRR MDCR #
CA800062078OtherTAX ID
NJ223596388OtherTAX IDENTIFICATION NUMBER
NJ650022786OtherRR MDCR #
CAW17206Medicare UPIN
NJP51788Medicare UPIN
CA1699840934Medicare PIN