Healthcare Provider Details

I. General information

NPI: 1134471790
Provider Name (Legal Business Name): RENALTA D'NET FLEMING ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 RENAISSANCE BLVD APT. 101
MIRAMAR FL
33025-5683
US

IV. Provider business mailing address

2081 RENAISSANCE BLVD APT. 101
MIRAMAR FL
33025-5683
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-3378
  • Fax:
Mailing address:
  • Phone: 954-438-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL3394
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: