Provider Demographics
NPI:1285837971
Name:SALINAS, RENEE NICOLE (PT)
Entity Type:Individual
Prefix:PROF
First Name:RENEE
Middle Name:NICOLE
Last Name:SALINAS
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 1:1620 READ RD
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2710
Mailing Address - Country:US
Mailing Address - Phone:601-798-1811
Mailing Address - Fax:601-798-2362
Practice Address - Street 1:1620 READ RD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2710
Practice Address - Country:US
Practice Address - Phone:601-798-1811
Practice Address - Fax:601-798-2362
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07167R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT4303OtherPT LICENSE
LA07167ROtherLA PT LICENSE NUMBER
LA260038623OtherCLINIC TAX ID