Basic Information
| Provider Information | |||||||||
| NPI: | 1487171419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | KATLYNNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT DPT | ||||||||
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| OtherLastName: | RAY | ||||||||
| OtherFirstName: | KATIE | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 609 N FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | WATKINS GLEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148911302 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 STEUBEN ST | ||||||||
| Address2: | |||||||||
| City: | MONTOUR FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148659740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075358616 | ||||||||
| FaxNumber: | 6042101965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 042043-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.