Provider Demographics
NPI:1679635163
Name:UNGARO, RENEE (LPT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:UNGARO
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:GARONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1397 S CANFIELD NILES RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4084
Mailing Address - Country:US
Mailing Address - Phone:330-953-0129
Mailing Address - Fax:330-953-0650
Practice Address - Street 1:1397 S CANFIELD NILES RD UNIT 1
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515
Practice Address - Country:US
Practice Address - Phone:330-953-0129
Practice Address - Fax:330-953-0650
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH009284OtherOH PTA LICENSE
OH0116995Medicaid