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General NPI Number Information
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NPI Number | 1528877560
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Entity Type | Individual
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Provider Name | RAYLEN NEIL MIRE LMT
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Gender | Male
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 1018 HARDING ST STE 205D
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City | LAFAYETTE
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State | LA
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Zip | 70503-2400
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Country | US
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Telephone | 337-366-1501
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Fax |
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Provider Business Mailing Address
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Address Line | 112 CANARY LN
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City | DUSON
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State | LA
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Zip | 70529-3827
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Country | US
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Telephone | 337-366-1501
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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 | 10066
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License Number State | LA
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