Provider Demographics
NPI:1639312184
Name:MCPHAUL, DEVEN IRENE (LMT)
Entity Type:Individual
Prefix:
First Name:DEVEN
Middle Name:IRENE
Last Name:MCPHAUL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NAUTICA DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7255
Mailing Address - Country:US
Mailing Address - Phone:904-483-2222
Mailing Address - Fax:904-483-2221
Practice Address - Street 1:725 NAUTICA DR
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7255
Practice Address - Country:US
Practice Address - Phone:904-483-2222
Practice Address - Fax:904-483-2221
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist