Provider Demographics
NPI:1114959673
Name:MASTERS & RAINES ADVANCED HEALING THERAPY CENTER LLC
Entity Type:Organization
Organization Name:MASTERS & RAINES ADVANCED HEALING THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-744-7774
Mailing Address - Street 1:13874 BENTLY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1987
Mailing Address - Country:US
Mailing Address - Phone:973-744-7774
Mailing Address - Fax:866-621-5272
Practice Address - Street 1:1425 BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4201
Practice Address - Country:US
Practice Address - Phone:973-744-7774
Practice Address - Fax:866-621-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00636900225700000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty