Provider Demographics
NPI:1902912264
Name:BRAY, CAROL C
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:C
Last Name:BRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N. COX STREET
Mailing Address - Street 2:SUITE 28
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5514
Mailing Address - Country:US
Mailing Address - Phone:336-626-6382
Mailing Address - Fax:336-626-7442
Practice Address - Street 1:350 N. COX STREET
Practice Address - Street 2:SUITE 28
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5514
Practice Address - Country:US
Practice Address - Phone:336-626-6382
Practice Address - Fax:336-626-7442
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC58010OtherMEDCOST
NC720779TMedicaid
NC0779TOtherBCBS
NC720779TMedicaid