Basic Information
| Provider Information | |||||||||
| NPI: | 1679752497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | TRAVIS | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 624 MAYSVILLE RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403539767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594994351 | ||||||||
| FaxNumber: | 8594994321 | ||||||||
| Practice Location | |||||||||
| Address1: | 624 MAYSVILLE RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403539767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594994351 | ||||||||
| FaxNumber: | 8594994321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT005138 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.