Healthcare Provider Details

I. General information

NPI: 1316795966
Provider Name (Legal Business Name): RAPEEWAN KANNAWAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S ELM ST
APEX NC
27502-1801
US

IV. Provider business mailing address

770 ORANGE OAK LN
APEX NC
27523-5101
US

V. Phone/Fax

Practice location:
  • Phone: 910-477-0915
  • Fax:
Mailing address:
  • Phone: 910-477-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17602
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: