Provider Demographics
NPI:1841533304
Name:RAY, DAVID JONATHON (LMP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JONATHON
Last Name:RAY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BRISTOL CT SW
Mailing Address - Street 2:SUITE 102 A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6003
Mailing Address - Country:US
Mailing Address - Phone:360-350-0539
Mailing Address - Fax:360-539-7336
Practice Address - Street 1:2401 BRISTOL CT SW
Practice Address - Street 2:SUITE 102 A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6003
Practice Address - Country:US
Practice Address - Phone:360-350-0539
Practice Address - Fax:360-539-7336
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60335488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist