Provider Demographics
NPI:1528877560
Name:MIRE, RAYLEN NEIL (LMT)
Entity type:Individual
Prefix:MR
First Name:RAYLEN
Middle Name:NEIL
Last Name:MIRE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CANARY LN
Mailing Address - Street 2:
Mailing Address - City:DUSON
Mailing Address - State:LA
Mailing Address - Zip Code:70529-3827
Mailing Address - Country:US
Mailing Address - Phone:337-366-1501
Mailing Address - Fax:
Practice Address - Street 1:1018 HARDING ST STE 205D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2400
Practice Address - Country:US
Practice Address - Phone:337-366-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist