Healthcare Provider Details

I. General information

NPI: 1124257464
Provider Name (Legal Business Name): LAURI MICHELE RANCHEL MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17419 BRIDGE HILL CT
TAMPA FL
33647-3467
US

IV. Provider business mailing address

17419 BRIDGE HILL CT
TAMPA FL
33647-3467
US

V. Phone/Fax

Practice location:
  • Phone: 813-907-7879
  • Fax: 813-994-3080
Mailing address:
  • Phone: 813-907-7879
  • Fax: 813-994-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberPT23043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: