Provider Demographics
NPI:1992208177
Name:RAY, BETH (LPTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 COUNTY ROAD 1212
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:TX
Mailing Address - Zip Code:75643-4359
Mailing Address - Country:US
Mailing Address - Phone:903-754-7813
Mailing Address - Fax:
Practice Address - Street 1:143 COUNTY ROAD 1212
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:TX
Practice Address - Zip Code:75643-4359
Practice Address - Country:US
Practice Address - Phone:903-754-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2005096225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant