Provider Demographics
NPI:1326724774
Name:OSBORNE, RENEA SUE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RENEA
Middle Name:SUE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:RENEA
Other - Middle Name:SUE
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:882 HORSE FORK RD
Mailing Address - Street 2:
Mailing Address - City:WALLBACK
Mailing Address - State:WV
Mailing Address - Zip Code:25285-9532
Mailing Address - Country:US
Mailing Address - Phone:304-932-5440
Mailing Address - Fax:
Practice Address - Street 1:100 KANAWHA BLVD W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2300
Practice Address - Country:US
Practice Address - Phone:304-346-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002269225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant