Provider Demographics
NPI:1043922412
Name:ROSS, RAYMONICA P (LMT,CMLDT)
Entity Type:Individual
Prefix:MRS
First Name:RAYMONICA
Middle Name:P
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMT,CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 UNION PACIFIC DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7612
Mailing Address - Country:US
Mailing Address - Phone:904-465-6892
Mailing Address - Fax:
Practice Address - Street 1:3843 UNION PACIFIC DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7612
Practice Address - Country:US
Practice Address - Phone:904-465-6892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA90506225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist