Provider Demographics
NPI:1346751450
Name:BISCHOFF, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BISCHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:KAY
Other - Last Name:BISCHOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:610 LADY DIANA DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7681
Mailing Address - Country:US
Mailing Address - Phone:863-956-6567
Mailing Address - Fax:
Practice Address - Street 1:610 LADY DIANA DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7681
Practice Address - Country:US
Practice Address - Phone:863-956-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL71136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty