Provider Demographics
NPI:1245540244
Name:PAJONK, GARY DAVID (RN, LMT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DAVID
Last Name:PAJONK
Suffix:
Gender:M
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 BONITA BEACH RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4155
Mailing Address - Country:US
Mailing Address - Phone:239-992-5498
Mailing Address - Fax:
Practice Address - Street 1:3411 BONITA BEACH RD
Practice Address - Street 2:SUITE 305
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4155
Practice Address - Country:US
Practice Address - Phone:239-992-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-09
Last Update Date:2010-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL RN 1038922163WM1400X
FLMA 5079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist