Provider Demographics
NPI:1639477672
Name:PAUL-XAVIER, GRACE OKON (LMT)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:OKON
Last Name:PAUL-XAVIER
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 1:191 NE 210TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1008
Mailing Address - Country:US
Mailing Address - Phone:954-294-9403
Mailing Address - Fax:
Practice Address - Street 1:2655 E OAKLAND PARK BLVD STE 6
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1608
Practice Address - Country:US
Practice Address - Phone:954-564-9536
Practice Address - Fax:954-514-9298
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-21007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist