Provider Demographics
NPI:1750633194
Name:RENTROP PENA, KAY F (LMT)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:F
Last Name:RENTROP PENA
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 1:1400 WATERWAY COVE DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5759
Mailing Address - Country:US
Mailing Address - Phone:561-315-8751
Mailing Address - Fax:
Practice Address - Street 1:1400 WATERWAY COVE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5759
Practice Address - Country:US
Practice Address - Phone:561-315-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59873225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist