Provider Demographics
NPI:1124525605
Name:RANGNOW, PETRINA KAY
Entity type:Individual
Prefix:
First Name:PETRINA
Middle Name:KAY
Last Name:RANGNOW
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 1:291 COUNTY ROAD 4182
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:TX
Mailing Address - Zip Code:77962-8734
Mailing Address - Country:US
Mailing Address - Phone:361-212-4770
Mailing Address - Fax:
Practice Address - Street 1:248 WISTERIA LN
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-2545
Practice Address - Country:US
Practice Address - Phone:979-648-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215036224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant