Provider Demographics
NPI:1760233308
Name:DALLAS, RANAE LYNN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:RANAE
Middle Name:LYNN
Last Name:DALLAS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68744 DURANGO RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3896
Mailing Address - Country:US
Mailing Address - Phone:760-835-4349
Mailing Address - Fax:
Practice Address - Street 1:68744 DURANGO RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3896
Practice Address - Country:US
Practice Address - Phone:760-835-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist