Provider Demographics
NPI:1962019463
Name:TOWNSEND, DEVIN LAMAIL
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:LAMAIL
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 LIBERTY PARK DR APT 2105
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-3707
Mailing Address - Country:US
Mailing Address - Phone:845-728-5715
Mailing Address - Fax:
Practice Address - Street 1:2525 LIBERTY PARK DR APT 2105
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-3707
Practice Address - Country:US
Practice Address - Phone:845-728-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029554225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist