Provider Demographics
NPI:1104940980
Name:WRAY, MARY E (LMT, NMT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:WRAY
Suffix:
Gender:F
Credentials:LMT, NMT
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 352752
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32135-2752
Mailing Address - Country:US
Mailing Address - Phone:386-212-6068
Mailing Address - Fax:
Practice Address - Street 1:21 OLD KINGS RD N STE 215
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8254
Practice Address - Country:US
Practice Address - Phone:386-212-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA27453175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath