Provider Demographics
NPI:1720841505
Name:DRAKE, CALVIN EUGENE JR (LMT)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:EUGENE
Last Name:DRAKE
Suffix:JR
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 1:2690 N STODGHILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8310
Mailing Address - Country:US
Mailing Address - Phone:469-332-4600
Mailing Address - Fax:
Practice Address - Street 1:2690 N STODGHILL RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8310
Practice Address - Country:US
Practice Address - Phone:469-332-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT116938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist