Provider Demographics
NPI:1154743409
Name:RANTALA, MARSHA (LMT)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:RANTALA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 CYPRESS TRACE DR
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4520
Mailing Address - Country:US
Mailing Address - Phone:772-422-7190
Mailing Address - Fax:
Practice Address - Street 1:1819 CYPRESS TRACE DR
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4520
Practice Address - Country:US
Practice Address - Phone:772-422-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist