Provider Demographics
NPI:1295961993
Name:HERNANDEZ, RENEE ANNELLE (CMT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANNELLE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 E 3RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5656
Mailing Address - Country:US
Mailing Address - Phone:970-402-8185
Mailing Address - Fax:
Practice Address - Street 1:329 E 3RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5656
Practice Address - Country:US
Practice Address - Phone:970-402-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27061347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist