Provider Demographics
NPI:1316211444
Name:LETBETTER, PRATCHAYANEE
Entity Type:Individual
Prefix:
First Name:PRATCHAYANEE
Middle Name:
Last Name:LETBETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 NE 1ST AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6606
Mailing Address - Country:US
Mailing Address - Phone:352-304-1878
Mailing Address - Fax:
Practice Address - Street 1:343 NE 1ST AVE
Practice Address - Street 2:UNIT A
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6606
Practice Address - Country:US
Practice Address - Phone:352-304-1878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 61432225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist