Provider Demographics
NPI:1336459841
Name:BLALOCK, RENEE S (PT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:S
Last Name:BLALOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:S
Other - Last Name:OHENDALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8455 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4803
Mailing Address - Country:US
Mailing Address - Phone:713-795-0891
Mailing Address - Fax:
Practice Address - Street 1:8455 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4803
Practice Address - Country:US
Practice Address - Phone:713-795-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1200491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist