Provider Demographics
NPI:1245482504
Name:DURRANCE, RONNIE LEE (LMT)
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:LEE
Last Name:DURRANCE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 SW 183RD TER
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-1844
Mailing Address - Country:US
Mailing Address - Phone:352-361-6243
Mailing Address - Fax:
Practice Address - Street 1:3926 SW 183RD TER
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-1844
Practice Address - Country:US
Practice Address - Phone:352-361-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46892225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist