Provider Demographics
NPI:1639488349
Name:FALCON, RONALD JAY (LMT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAY
Last Name:FALCON
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:PO BOX 121709
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32912-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4690 LIPSCOMB ST NE
Practice Address - Street 2:SUITE #6B
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2929
Practice Address - Country:US
Practice Address - Phone:321-952-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA #44011225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist