Provider Demographics
NPI:1215000658
Name:RAYNOR, WALTER RAYMOND (CO)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RAYMOND
Last Name:RAYNOR
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
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Mailing Address - Street 1:5311 E FLATCHER AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:813-985-5000
Mailing Address - Fax:813-985-4499
Practice Address - Street 1:2727 MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE 690
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-540-0100
Practice Address - Fax:813-248-0629
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLORT140222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist