RUSSELL PEN GAINES LMT
NPI 1639371008
Massage Therapist in Destin, FL
Active since June 05, 2007
About Russell Pen Gaines Lmt NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RUSSELL PEN GAINES LMT (NPI 1639371008) is an individual massage therapist in Destin, Florida, licensed in Florida (MA18637) and active in the NPI registry since June 2007.
NPPES Registry Identity
NPI1639371008
Entity TypeIndividualMale
Primary Taxonomy225700000X
Provider Legal NameRUSSELL PEN GAINESCredential: LMT
Location Address3999 COMMONS DR W, STE CDestin, FL 32541
Mailing Address17 Doral DrShalimar, FL 32579 · (850) 651-1732 · Fax (850) 651-1732
Phone(850) 837-9552
Sole ProprietorNo
Enumeration DateJune 5, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1639371008 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225700000X
License✔ Licensed in FL · MA18637
Definition
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.
3999 COMMONS DR W, Destin, FL 32541
Other Names 1
Professional Name (2)Russ Gaines Massage Therapy
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1639371008, enumerated as an "individual" on June 05, 2007.
The provider is located at 3999 COMMONS DR W STE C DESTIN, FL 32541 and the phone number is (850) 837-9552.
Massage Therapist with taxonomy code 225700000X.
