Provider Demographics
NPI:1992840359
Name:RANTALA, JANE P (LIC MASSAGE THERAPIS)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:P
Last Name:RANTALA
Suffix:
Gender:F
Credentials:LIC MASSAGE THERAPIS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:MCKEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606
Mailing Address - Country:US
Mailing Address - Phone:508-852-8261
Mailing Address - Fax:
Practice Address - Street 1:27 COVENTRY RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2132
Practice Address - Country:US
Practice Address - Phone:508-341-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1806225700000X
MA45225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist