Provider Demographics
NPI:1982324091
Name:LANDRUM, PATRICE HORINBEIN
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:HORINBEIN
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DRAGONFLY MEDICAL MASSAGE
Mailing Address - Street 2:11038 SC 707
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576
Mailing Address - Country:US
Mailing Address - Phone:843-215-2151
Mailing Address - Fax:843-492-5113
Practice Address - Street 1:DRAGONFLY MEDICAL MASSAGE
Practice Address - Street 2:11038 SC 707
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-215-2151
Practice Address - Fax:843-492-5113
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11357225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist