Healthcare Provider Details

I. General information

NPI: 1114959673
Provider Name (Legal Business Name): MASTERS & RAINES ADVANCED HEALING THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 BROAD ST STE 4
CLIFTON NJ
07013-4201
US

IV. Provider business mailing address

13874 BENTLY CIR
FORT MYERS FL
33912-1987
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-7774
  • Fax: 866-621-5272
Mailing address:
  • Phone: 973-744-7774
  • Fax: 866-621-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00636900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEY RAINES
Title or Position: DIRECTOR
Credential:
Phone: 973-744-7774