Provider Demographics
NPI:1366922254
Name:RAYTSIN, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:RAYTSIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 SW STEPHANIE WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2328
Mailing Address - Country:US
Mailing Address - Phone:772-238-0702
Mailing Address - Fax:
Practice Address - Street 1:10560 SW STEPHANIE WAY APT 202
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2328
Practice Address - Country:US
Practice Address - Phone:772-238-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35846225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist