Provider Demographics
NPI:1629595798
Name:PRATHER, PAIGE LYNN (LPN, LMT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:LYNN
Last Name:PRATHER
Suffix:
Gender:F
Credentials:LPN, LMT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:LYNN
Other - Last Name:RINEHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5225 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1034
Mailing Address - Country:US
Mailing Address - Phone:239-321-2989
Mailing Address - Fax:
Practice Address - Street 1:5225 7TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1034
Practice Address - Country:US
Practice Address - Phone:239-321-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA82606172M00000X, 225700000X
FLPN5249933164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No172M00000XOther Service ProvidersMechanotherapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA82606OtherFLORIDA BOARD OF MASSAGE
FLPN5249933OtherFLORIDA BOARD OF NURSING