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General NPI Number Information
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NPI Number | 1215790753
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Entity Type | Individual
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Provider Name | RAZAN GREGORY
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Gender | Female
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 1310 SE MAYNARD RD STE 204-A
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City | CARY
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State | NC
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Zip | 27511-3615
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Country | US
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Telephone | 919-443-5068
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Fax |
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Provider Business Mailing Address
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Address Line | 1719 E CORNWALLIS RD APT H
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City | DURHAM
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State | NC
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Zip | 27713-1456
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Country | US
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Telephone | 202-300-3104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 16264
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License Number State | NC
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