Provider Demographics
NPI:1013234558
Name:RAYBORN, MARTHA N (LMT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:N
Last Name:RAYBORN
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 1:216 KATE RD
Mailing Address - Street 2:
Mailing Address - City:SALVISA
Mailing Address - State:KY
Mailing Address - Zip Code:40372-9738
Mailing Address - Country:US
Mailing Address - Phone:859-489-0155
Mailing Address - Fax:
Practice Address - Street 1:216 KATE RD
Practice Address - Street 2:
Practice Address - City:SALVISA
Practice Address - State:KY
Practice Address - Zip Code:40372-9738
Practice Address - Country:US
Practice Address - Phone:859-489-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2551225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist