Provider Demographics
NPI:1366056491
Name:RENTERIA, JOSEPH (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MORNING DAWN LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3733
Mailing Address - Country:US
Mailing Address - Phone:480-703-8231
Mailing Address - Fax:
Practice Address - Street 1:1700 E PALM VALLEY BLVD STE 395
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4683
Practice Address - Country:US
Practice Address - Phone:512-399-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist