Provider Demographics
NPI:1760149926
Name:SCRANTA, CORALEA (LMT/NCBTMB)
Entity Type:Individual
Prefix:
First Name:CORALEA
Middle Name:
Last Name:SCRANTA
Suffix:
Gender:F
Credentials:LMT/NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4887 W GLEESON RD
Mailing Address - Street 2:
Mailing Address - City:ELFRIDA
Mailing Address - State:AZ
Mailing Address - Zip Code:85610-9059
Mailing Address - Country:US
Mailing Address - Phone:520-508-5395
Mailing Address - Fax:
Practice Address - Street 1:4887 W GLEESON RD
Practice Address - Street 2:
Practice Address - City:ELFRIDA
Practice Address - State:AZ
Practice Address - Zip Code:85610-9059
Practice Address - Country:US
Practice Address - Phone:520-508-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 251S00000X
AZ2000288225700000X
AR1859225700000X
AR9025225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251S00000XAgenciesCommunity/Behavioral Health