Provider Demographics
NPI:1033460670
Name:RENNE, MARCIA PETRONELLA (LMP, MMP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:PETRONELLA
Last Name:RENNE
Suffix:
Gender:F
Credentials:LMP, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 BRIGHTSEAT RD
Mailing Address - Street 2:APT 302
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3509
Mailing Address - Country:US
Mailing Address - Phone:240-701-7700
Mailing Address - Fax:
Practice Address - Street 1:4230 FORBES BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4351
Practice Address - Country:US
Practice Address - Phone:240-701-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR01390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist