Provider Demographics
NPI:1568664118
Name:MCPHERRON, RENA (LMT)
Entity Type:Individual
Prefix:MS
First Name:RENA
Middle Name:
Last Name:MCPHERRON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 E MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-3732
Mailing Address - Country:US
Mailing Address - Phone:407-947-9945
Mailing Address - Fax:
Practice Address - Street 1:918 E MINNESOTA AVE
Practice Address - Street 2:1705 N.W. 6T ST, GAINESVILLE, FL 32601
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3732
Practice Address - Country:US
Practice Address - Phone:407-947-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0012724172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist