Provider Demographics
NPI:1033269121
Name:SEGAL, MARIANNE (LMT)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1266 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4426
Mailing Address - Country:US
Mailing Address - Phone:727-585-1636
Mailing Address - Fax:
Practice Address - Street 1:360 CLEARWATER LARGO RD N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2335
Practice Address - Country:US
Practice Address - Phone:727-585-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist