MEDICARE: RENEE F STONE RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	21261	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-27704	OTHER	AL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1760530257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE F STONE RPT

Provider Business Mailing Address
First Line	:	805 FRIENDSHIP RD
Second Line	:
City	:	TALLASSEE
State	:	AL
Zip	:	36078-1234
Country	:	US
Telephone Number	:	334-283-3734
Fax Number	:	334-283-3758

Provider Business Practice Location Address
First Line	:	805 FRIENDSHIP RD
Second Line	:
City	:	TALLASSEE
State	:	AL
Zip	:	36078-1234
Country	:	US
Telephone Number	:	334-283-3734
Fax Number	:	334-283-3758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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Directions to “ RENEE F STONE RPT” Practice Location

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