Provider Demographics
NPI:1306050489
Name:SHUSTER, RENEE M (PTA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 GERTRUDE ST
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-9771
Mailing Address - Country:US
Mailing Address - Phone:724-527-2325
Mailing Address - Fax:
Practice Address - Street 1:911 LIGONIER ST STE 001
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1843
Practice Address - Country:US
Practice Address - Phone:724-537-9577
Practice Address - Fax:724-537-0195
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE005738L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant