Provider Demographics
NPI:1699058289
Name:WRAY, MELINDA BLAINE (DPT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:BLAINE
Last Name:WRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 SHADY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:VIOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72583-9130
Mailing Address - Country:US
Mailing Address - Phone:870-321-4457
Mailing Address - Fax:870-895-2626
Practice Address - Street 1:9818 HWY 62 W
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:AR
Practice Address - Zip Code:72583
Practice Address - Country:US
Practice Address - Phone:870-321-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist