Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 0017506 | FL |
NPI | 1003060625 |
---|---|
Provider Name | Joel Rayburn |
First Address | Orlando, FL 32806-4515 |
Second Address | Orlando, FL 32806-4983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 09/10/2013 |