Provider Demographics
NPI:1306564935
Name:MARENO, PHILLIP JOSEPH JR (CTRS)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:JOSEPH
Last Name:MARENO
Suffix:JR
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 EDISON WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4135
Mailing Address - Country:US
Mailing Address - Phone:775-858-3303
Mailing Address - Fax:
Practice Address - Street 1:690 EDISON WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4135
Practice Address - Country:US
Practice Address - Phone:775-772-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32110225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist