Provider Demographics
NPI:1518620749
Name:PANTANI, GRETA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:
Last Name:PANTANI
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 1:800 PARKVIEW DR APT 429
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2925
Mailing Address - Country:US
Mailing Address - Phone:954-706-3785
Mailing Address - Fax:
Practice Address - Street 1:1830 S OCEAN DR
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7696
Practice Address - Country:US
Practice Address - Phone:954-883-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA91405225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist