Provider Demographics
NPI:1811911241
Name:RAY PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:RAY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT PHYSICAL THERAPY
Authorized Official - Phone:970-207-1500
Mailing Address - Street 1:3938 JOHN F KENNEDY PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-207-1500
Mailing Address - Fax:970-207-0075
Practice Address - Street 1:3938 JOHN F KENNEDY PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-207-1500
Practice Address - Fax:970-207-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C417108Medicare ID - Type Unspecified