Provider Demographics
NPI:1265284905
Name:CAMDEN, RAYMOND MICHAEL (LMT)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MICHAEL
Last Name:CAMDEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 STATE HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-8207
Mailing Address - Country:US
Mailing Address - Phone:573-430-9963
Mailing Address - Fax:
Practice Address - Street 1:301 N WASHINGTON ST STE 6
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1750
Practice Address - Country:US
Practice Address - Phone:573-430-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022021171225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist