RUSSELL PEN GAINES LMT NPI 1639371008

NPI Information

NPI: 1639371008
Provider Name: RUSSELL PEN GAINES, LMT
Classification: Massage Therapist - 225700000X
Entity Type: Individual
Address:
3999 COMMONS DR W
STE C
DESTIN, FL
ZIP 32541
Phone: (850) 837-9552
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Russell Pen Gaines, LMT is a massage therapist in Destin, FL. The provider is an individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. Russell Pen Gaines, LMT NPI is 1639371008. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3999 COMMONS DR W
STE C
DESTIN, FL
ZIP 32541
Phone: (850) 837-9552

The enumeration date for this NPI number is 6/5/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	225700000X	Massage Therapist		MA18637	FLORIDA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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