Provider Demographics
NPI:1073289823
Name:NEAL, RAYBURN THOMAS III (LMT)
Entity Type:Individual
Prefix:
First Name:RAYBURN
Middle Name:THOMAS
Last Name:NEAL
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 REED RD STE G
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3074
Mailing Address - Country:US
Mailing Address - Phone:614-769-7687
Mailing Address - Fax:
Practice Address - Street 1:4700 REED RD STE G
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3074
Practice Address - Country:US
Practice Address - Phone:614-769-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist