Provider Demographics
NPI:1639564701
Name:OUTLAW, RENEE LYNN (CMT, LMT,)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:CMT, LMT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MT DIABLO BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3540
Mailing Address - Country:US
Mailing Address - Phone:925-297-5124
Mailing Address - Fax:
Practice Address - Street 1:3705 MT DIABLO BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3540
Practice Address - Country:US
Practice Address - Phone:925-297-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No174H00000XOther Service ProvidersHealth Educator