Provider Demographics
NPI:1386078749
Name:CALLANTA, RENE (LMT)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:CALLANTA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:
Other - Last Name:LEDOUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:315 N RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1617
Mailing Address - Country:US
Mailing Address - Phone:386-427-8403
Mailing Address - Fax:386-427-8410
Practice Address - Street 1:315 N RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1617
Practice Address - Country:US
Practice Address - Phone:386-427-8403
Practice Address - Fax:386-427-8410
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA69422225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist