Provider Demographics
NPI:1134471790
Name:FLEMING, RENALTA D'NET (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:RENALTA
Middle Name:D'NET
Last Name:FLEMING
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 RENAISSANCE BLVD
Mailing Address - Street 2:APT. 101
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5683
Mailing Address - Country:US
Mailing Address - Phone:954-438-3378
Mailing Address - Fax:
Practice Address - Street 1:2081 RENAISSANCE BLVD
Practice Address - Street 2:APT. 101
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5683
Practice Address - Country:US
Practice Address - Phone:954-438-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL33942255A2300X
225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist