Provider Demographics
NPI:1538545454
Name:RAWDON, GENA
Entity type:Individual
Prefix:MS
First Name:GENA
Middle Name:
Last Name:RAWDON
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 1:1634 SLAUGHTER RD STE C
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-5914
Mailing Address - Country:US
Mailing Address - Phone:256-430-9756
Mailing Address - Fax:256-430-9757
Practice Address - Street 1:1634 SLAUGHTER RD STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-5914
Practice Address - Country:US
Practice Address - Phone:256-430-9756
Practice Address - Fax:256-430-9757
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2939225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist