Provider Demographics
NPI:1376760249
Name:RATLIFF, MARY K (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:RATLIFF
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 1:328 HOWARD ST W
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-2306
Mailing Address - Country:US
Mailing Address - Phone:386-590-1821
Mailing Address - Fax:386-364-7002
Practice Address - Street 1:328 HOWARD ST W
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2306
Practice Address - Country:US
Practice Address - Phone:386-590-1821
Practice Address - Fax:386-364-7002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist