Provider Demographics
NPI:1598818809
Name:DARR, T. REX (LMT)
Entity Type:Individual
Prefix:MR
First Name:T. REX
Middle Name:
Last Name:DARR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14712 NW 145TH TER
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-8630
Mailing Address - Country:US
Mailing Address - Phone:386-462-0032
Mailing Address - Fax:386-462-0032
Practice Address - Street 1:14862 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-8590
Practice Address - Country:US
Practice Address - Phone:386-462-0032
Practice Address - Fax:386-462-0032
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA24667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA24667OtherMASSAGE LICENSE NUMBER
FLC8003OtherPROVIDER NUMBER