Provider Demographics
NPI:1790808566
Name:ALLEN, RAYFORD BEAUFORD III (LMT)
Entity Type:Individual
Prefix:MR
First Name:RAYFORD
Middle Name:BEAUFORD
Last Name:ALLEN
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14907 GREELEY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-1963
Mailing Address - Country:US
Mailing Address - Phone:813-298-7684
Mailing Address - Fax:813-968-7667
Practice Address - Street 1:19007 NORTH DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548
Practice Address - Country:US
Practice Address - Phone:813-298-7684
Practice Address - Fax:813-968-7667
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-28726172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist