Provider Demographics
NPI:1548893308
Name:RAY, DOROTHY KATHLEEN (DPT)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:KATHLEEN
Last Name:RAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:KATHLEN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:KIRBY
Mailing Address - State:AR
Mailing Address - Zip Code:71950-0196
Mailing Address - Country:US
Mailing Address - Phone:870-816-5690
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTE N12 AND N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-0649
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
ARPT4551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPT4551OtherAR STATE BOARD OF PHYSICAL THERAPY