Provider Demographics
NPI:1144392051
Name:FLOYD, CORRINE M (LMT)
Entity Type:Individual
Prefix:MR
First Name:CORRINE
Middle Name:M
Last Name:FLOYD
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 1:25278 AUDRAIN ROAD 808
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-6345
Mailing Address - Country:US
Mailing Address - Phone:573-721-3967
Mailing Address - Fax:
Practice Address - Street 1:713 EAST JACKSON
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265
Practice Address - Country:US
Practice Address - Phone:573-582-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003028345225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist