Provider Demographics
NPI:1184776320
Name:MAREINA, RHONDA (PT CSCS CPI)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:
Last Name:MAREINA
Suffix:
Gender:F
Credentials:PT CSCS CPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 MEINECKE AVE # B
Mailing Address - Street 2:
Mailing Address - City:SLO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:805-546-8040
Mailing Address - Fax:805-546-0440
Practice Address - Street 1:894 MEINECKE AVE # B
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:805-546-8040
Practice Address - Fax:805-546-0440
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT19734CMedicare ID - Type Unspecified