Provider Demographics
NPI:1649368028
Name:MUNN, RAY DEREK (PT, MPT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:DEREK
Last Name:MUNN
Suffix:
Gender:M
Credentials:PT, MPT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1534
Mailing Address - Country:US
Mailing Address - Phone:617-306-6519
Mailing Address - Fax:617-244-4672
Practice Address - Street 1:30 PLAYSTEAD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2125
Practice Address - Country:US
Practice Address - Phone:617-306-6519
Practice Address - Fax:617-244-4672
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist