Provider Demographics
NPI:1053925495
Name:BAILEY, RENATA (LMT)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351 CHIPPENDALE CIR E
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2237
Mailing Address - Country:US
Mailing Address - Phone:239-229-6628
Mailing Address - Fax:
Practice Address - Street 1:5351 CHIPPENDALE CIR E
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-2237
Practice Address - Country:US
Practice Address - Phone:239-462-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist