Provider Demographics
NPI:1073541249
Name:DEMARINO, RENEE (PT)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:DEMARINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:MEDICAL OFFICE BUILDING # 105
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-466-8811
Mailing Address - Fax:412-466-1508
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:MEDICAL OFFICE BUILDING # 105
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-466-8811
Practice Address - Fax:412-466-1508
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011239L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015935850002Medicaid
PA396610Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER