Provider Demographics
NPI:1194329664
Name:SCRANTA, SHIRLEY (LMT)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SCRANTA
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 1:6055C KELLERS CHURCH RD STE C-220
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1017
Mailing Address - Country:US
Mailing Address - Phone:570-499-9626
Mailing Address - Fax:
Practice Address - Street 1:6055C KELLERS CHURCH RD STE C-220
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-1017
Practice Address - Country:US
Practice Address - Phone:570-499-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG006841225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist