Provider Demographics
NPI:1447757356
Name:SELF, RAINNELLA (REIKI MASTER, LMT)
Entity Type:Individual
Prefix:
First Name:RAINNELLA
Middle Name:
Last Name:SELF
Suffix:
Gender:F
Credentials:REIKI MASTER, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CAMINO GARDENS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5823
Mailing Address - Country:US
Mailing Address - Phone:561-430-5760
Mailing Address - Fax:
Practice Address - Street 1:301 CAMINO GARDENS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5823
Practice Address - Country:US
Practice Address - Phone:561-430-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA81043225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty