Provider Demographics
NPI:1548733876
Name:MCCRAY, CHARLES ANTHONY
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANTHONY
Last Name:MCCRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 NEFF AVE STE 5000
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8053
Mailing Address - Country:US
Mailing Address - Phone:540-560-4010
Mailing Address - Fax:
Practice Address - Street 1:590 NEFF AVE STE 5000
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8053
Practice Address - Country:US
Practice Address - Phone:540-560-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019016927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist