Provider Demographics
NPI:1669660551
Name:HINKLE, IVADEL RAE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:IVADEL
Middle Name:RAE
Last Name:HINKLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:IVADEL
Other - Middle Name:RAE
Other - Last Name:BOWERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:5029 KIRKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1736
Mailing Address - Country:US
Mailing Address - Phone:352-238-6417
Mailing Address - Fax:
Practice Address - Street 1:1292 LORI DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4561
Practice Address - Country:US
Practice Address - Phone:352-686-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43981225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist