Provider Demographics
NPI:1831408970
Name:ROHAN, RENEE B
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:B
Last Name:ROHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:B
Other - Last Name:ROHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8 THISTLE DR
Mailing Address - Street 2:MONTGOMERY
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2007
Mailing Address - Country:US
Mailing Address - Phone:845-457-4366
Mailing Address - Fax:
Practice Address - Street 1:8 THISTLE DR
Practice Address - Street 2:MONTGOMERY
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2007
Practice Address - Country:US
Practice Address - Phone:845-457-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist