Provider Demographics
NPI:1104000454
Name:MCCRAW, LASHAWNTE ZAKIEK SR (NMT)
Entity Type:Individual
Prefix:
First Name:LASHAWNTE
Middle Name:ZAKIEK
Last Name:MCCRAW
Suffix:SR
Gender:M
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 STOCKTON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3590
Mailing Address - Country:US
Mailing Address - Phone:904-388-1300
Mailing Address - Fax:904-388-1302
Practice Address - Street 1:869 STOCKTON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3590
Practice Address - Country:US
Practice Address - Phone:904-388-1300
Practice Address - Fax:904-388-1302
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist