Provider Demographics
NPI:1346916194
Name:RENOLAYAN, JAN ROLAND CONTRERAS (PT)
Entity Type:Individual
Prefix:
First Name:JAN ROLAND
Middle Name:CONTRERAS
Last Name:RENOLAYAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 SPRINGDALE CT APT I5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1625
Mailing Address - Country:US
Mailing Address - Phone:706-847-2853
Mailing Address - Fax:
Practice Address - Street 1:225 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:GA
Practice Address - Zip Code:31780-5544
Practice Address - Country:US
Practice Address - Phone:229-824-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist