Provider Demographics
NPI:1396283925
Name:RALEY, NANCY (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RALEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 HIGHWAY 165
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-3322
Mailing Address - Country:US
Mailing Address - Phone:318-649-9826
Mailing Address - Fax:318-649-9827
Practice Address - Street 1:7726 HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-3322
Practice Address - Country:US
Practice Address - Phone:318-649-9826
Practice Address - Fax:318-649-9827
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist