Provider Demographics
NPI:1306413380
Name:RAI, TRESA (MSGC)
Entity Type:Individual
Prefix:
First Name:TRESA
Middle Name:
Last Name:RAI
Suffix:
Gender:F
Credentials:MSGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8931 COLONIAL CENTER DRIVE
Mailing Address - Street 2:BLDG B SUITE 200
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905
Mailing Address - Country:US
Mailing Address - Phone:239-343-9625
Mailing Address - Fax:
Practice Address - Street 1:8931 COLONIAL CENTER DRIVE
Practice Address - Street 2:BLDG B SUITE 200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905
Practice Address - Country:US
Practice Address - Phone:239-343-9625
Practice Address - Fax:239-343-9561
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS