Provider Demographics
NPI:1508895368
Name:PANUCCI, RONDA LEE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:RONDA
Middle Name:LEE
Last Name:PANUCCI
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 1:1078 S FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4510
Mailing Address - Country:US
Mailing Address - Phone:850-683-1125
Mailing Address - Fax:850-683-0981
Practice Address - Street 1:1078 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4510
Practice Address - Country:US
Practice Address - Phone:850-683-1125
Practice Address - Fax:850-683-0981
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0016952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC6565OtherBCBS PROVIDER #