Provider Demographics
NPI:1538250865
Name:BARSALOUX, RAYMOND A (OTR/L)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:A
Last Name:BARSALOUX
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 CAPISTRANO CT
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2760
Mailing Address - Country:US
Mailing Address - Phone:727-538-9892
Mailing Address - Fax:
Practice Address - Street 1:558 CAPISTRANO CT
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2760
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9440
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 5653283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT 5653OtherFL STATE LICENSE NO.