Provider Demographics
NPI:1154835924
Name:GAINES, FELICIA PATRICE (LMT)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:PATRICE
Last Name:GAINES
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 1:6941 N TRENHOLM RD STE R2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-1728
Mailing Address - Country:US
Mailing Address - Phone:864-324-6253
Mailing Address - Fax:
Practice Address - Street 1:6941 N TRENHOLM RD STE R2
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-1728
Practice Address - Country:US
Practice Address - Phone:864-324-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist