Provider Demographics
NPI:1356749378
Name:RENO, ANGEL (LMT)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:RENO
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 1:7509 NW 73RD PL
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-4439
Mailing Address - Country:US
Mailing Address - Phone:816-886-8704
Mailing Address - Fax:
Practice Address - Street 1:7211 NW 83RD ST
Practice Address - Street 2:SUITE 330-E
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-6022
Practice Address - Country:US
Practice Address - Phone:816-886-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010013808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist