Provider Demographics
NPI:1891044244
Name:CRAYNON, ROSE MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARIE
Last Name:CRAYNON
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 1:107 BRANDON WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-8500
Mailing Address - Country:US
Mailing Address - Phone:859-499-1009
Mailing Address - Fax:
Practice Address - Street 1:107 BRANDON WAY
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-8500
Practice Address - Country:US
Practice Address - Phone:859-499-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-493225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist