Provider Demographics
NPI:1194505339
Name:ETIENNE, TRAYVOND (MS)
Entity type:Individual
Prefix:
First Name:TRAYVOND
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2901 CURRY FORD RD STE 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3353
Mailing Address - Country:US
Mailing Address - Phone:407-203-5984
Mailing Address - Fax:407-930-6070
Practice Address - Street 1:2901 CURRY FORD RD STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3353
Practice Address - Country:US
Practice Address - Phone:407-203-5984
Practice Address - Fax:407-930-6070
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist