Provider Demographics
NPI:1154719219
Name:BOTROS, RENETA A (DPT)
Entity type:Individual
Prefix:
First Name:RENETA
Middle Name:A
Last Name:BOTROS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RENETA
Other - Middle Name:AMBER
Other - Last Name:KAETHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1395 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6525
Mailing Address - Country:US
Mailing Address - Phone:412-657-2873
Mailing Address - Fax:
Practice Address - Street 1:1395 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6525
Practice Address - Country:US
Practice Address - Phone:412-657-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist