Individual provider · Type 1 NPI

Russell Pen Gaines, LMT

Massage Therapist · Destin, FL

NPI number 1639371008 Active

Practice location

3999 Commons Dr W, Ste C
Destin, FL 32541

Call (850) 837-9552 Map

Mailing address

17 Doral Dr
Shalimar, FL 32579

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000XMA18637 (FL)

Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

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About NPI 1639371008

Russell Pen Gaines, LMT's National Provider Identifier is 1639371008, issued on Jun 5, 2007. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Destin, FL. The record was last updated on Jul 8, 2007.