MEDICARE: TINA RENICK RD

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	133V00000X	Registered Dietitian	824090	VA

General Provider Information

NPI Number	:	1942446695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA RENICK RD

Provider Business Mailing Address
First Line	:	1310 3RD ST SW STE 3
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-5219
Country	:	US
Telephone Number	:	540-225-2501
Fax Number	:	540-859-1310

Provider Business Practice Location Address
First Line	:	1310 3RD ST SW STE 3
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-5219
Country	:	US
Telephone Number	:	540-225-2501
Fax Number	:

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

Provider Enumeration Date	:	12/31/2008
Last Update Date	:	11/15/2021

Similar Medicare Providers

1295831113 — SPINE AND ORTHOPEDIC REHAB OF VA INC
Practice Location Address:

1310 3RD ST SW
ROANOKE, VA
24016-5219

Practice Phone: 540-985-6500
Practice Fax: 540-985-6501

1770689788 — ERIC CHRISTIAN REICHARDT M.P.T.
Practice Location Address:

1310 3RD ST SW
ROANOKE, VA
24016-5219

Practice Phone: 540-985-6500
Practice Fax: 540-985-6501

1053405613 — ELEANOR ELIZABETH WRIGHT LCSW
Practice Location Address:

1310 3RD ST SW STE 2
ROANOKE, VA
24016-5219

Practice Phone: 540-815-7886
Practice Fax: 833-944-2522

1831565902 — LISA BIVENS LMT
Practice Location Address:

1310 3RD ST SW
ROANOKE, VA
24016-5219

Practice Phone: 540-797-5851
Practice Fax:

1326357112 — CORBAN NEAL M.A., CCC-SLP
Practice Location Address:

4428 PHEASANT RIDGE RD
ROANOKE, VA
24014-5219

Practice Phone: 540-400-6430
Practice Fax:

1902802457 — DR. GREGORY L WALTER DC
Practice Location Address:

5219 PETERS CREEK RD NW , SUITE 5
ROANOKE, VA
24019-3864

Practice Phone: 540-362-0811
Practice Fax: 540-362-5025

Directions to “ TINA RENICK RD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.