Provider Demographics
NPI:1952096844
Name:AMY RAY PT LLC
Entity Type:Organization
Organization Name:AMY RAY PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-450-1589
Mailing Address - Street 1:1272 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9673
Mailing Address - Country:US
Mailing Address - Phone:317-450-1589
Mailing Address - Fax:
Practice Address - Street 1:600 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9206
Practice Address - Country:US
Practice Address - Phone:317-450-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy