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General NPI Number Information
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NPI Number | 1336652361
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE RENEAU PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 6100 WESTERN PL STE 320
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City | FORT WORTH
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State | TX
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Zip | 76107-4665
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Country | US
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Telephone | 817-564-0107
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 MAPLEWOOD LN
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City | CROWLEY
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State | TX
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Zip | 76036-4306
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Country | US
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Telephone | 681-597-7606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1242395
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License Number State | TX
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