Provider Demographics
NPI:1073256061
Name:TUMGEON, RAPEEPORN (LMT)
Entity Type:Individual
Prefix:
First Name:RAPEEPORN
Middle Name:
Last Name:TUMGEON
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 1:2432 N SHARON AMITY RD STE 205-A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7717
Mailing Address - Country:US
Mailing Address - Phone:704-609-7611
Mailing Address - Fax:
Practice Address - Street 1:2432 N SHARON AMITY RD STE 205-A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7717
Practice Address - Country:US
Practice Address - Phone:704-609-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist