Provider Demographics
NPI:1760258362
Name:GOMEZ, RENEE ELIZABETH
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ELIZABETH
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ELIZABETH
Other - Last Name:RENEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4614
Mailing Address - Country:US
Mailing Address - Phone:253-534-7623
Mailing Address - Fax:253-534-7610
Practice Address - Street 1:2901 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4614
Practice Address - Country:US
Practice Address - Phone:253-534-7623
Practice Address - Fax:253-534-7610
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160644319225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant