Provider Demographics
NPI:1366541963
Name:YUMANG, RAY A (PT)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:A
Last Name:YUMANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:TONTITOWN
Mailing Address - State:AR
Mailing Address - Zip Code:72770-0871
Mailing Address - Country:US
Mailing Address - Phone:479-751-3900
Mailing Address - Fax:
Practice Address - Street 1:1112 S 48TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5848
Practice Address - Country:US
Practice Address - Phone:479-751-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1125225100000X
AR2994225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U855OtherBLUE CROSS/BLUE SHIELD
AR5U855OtherBLUE CROSS/BLUE SHIELD