Provider Demographics
NPI:1265450076
Name:RENALES, CELINO CINCO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CELINO
Middle Name:CINCO
Last Name:RENALES
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3267
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7713
Mailing Address - Country:US
Mailing Address - Phone:479-271-9191
Mailing Address - Fax:479-271-9196
Practice Address - Street 1:593 HORSEBARN RD
Practice Address - Street 2:#101
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8795
Practice Address - Country:US
Practice Address - Phone:479-271-9191
Practice Address - Fax:479-271-9196
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y445OtherBLUE CROSS
AR5Y445Medicare PIN