Provider Demographics
NPI:1265696371
Name:RAY, KATHY SUE (PTA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:SUE
Last Name:RAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 N 700 E
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:IN
Mailing Address - Zip Code:47326-9042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7250 N 700 E
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:IN
Practice Address - Zip Code:47326-9042
Practice Address - Country:US
Practice Address - Phone:260-997-6152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002329A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant