Provider Demographics
NPI:1316795966
Name:KANNAWAT, RAPEEWAN
Entity type:Individual
Prefix:
First Name:RAPEEWAN
Middle Name:
Last Name:KANNAWAT
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 1:770 ORANGE OAK LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-5101
Mailing Address - Country:US
Mailing Address - Phone:910-477-0915
Mailing Address - Fax:
Practice Address - Street 1:309 S ELM ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1801
Practice Address - Country:US
Practice Address - Phone:910-477-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist