Provider Demographics
NPI:1912496217
Name:COLMANETTI SOARES, RENATA JULIA
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:JULIA
Last Name:COLMANETTI SOARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7734 WAGNER WAY APT B
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1028
Mailing Address - Country:US
Mailing Address - Phone:570-702-4805
Mailing Address - Fax:
Practice Address - Street 1:1515 THE FAIRWAY
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-1435
Practice Address - Country:US
Practice Address - Phone:215-885-6800
Practice Address - Fax:215-576-5862
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011670225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant