Provider Demographics
NPI:1295716504
Name:RAY, PEGGY (MPT)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 25TH ST S
Mailing Address - Street 2:PHYSICAN THERAPY
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-731-8888
Mailing Address - Fax:406-731-8935
Practice Address - Street 1:1401 25TH ST S
Practice Address - Street 2:PHYSICAN THERAPY
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-731-8888
Practice Address - Fax:406-731-8935
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT800PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0346596Medicaid
MT000061656OtherBC