Provider Demographics
NPI:1275230880
Name:RENOCK, CHRISTINA
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:RENOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 CHAPEL HILL CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9640
Mailing Address - Country:US
Mailing Address - Phone:812-327-4309
Mailing Address - Fax:
Practice Address - Street 1:7544 CHAPEL HILL CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9640
Practice Address - Country:US
Practice Address - Phone:812-327-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21304909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist