Provider Demographics
NPI:1528076791
Name:PINA, RENEE A (MPT)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:A
Last Name:PINA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14207 HIGGINS ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1252
Mailing Address - Country:US
Mailing Address - Phone:210-826-4492
Mailing Address - Fax:210-930-5513
Practice Address - Street 1:14207 HIGGINS ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1252
Practice Address - Country:US
Practice Address - Phone:210-826-4492
Practice Address - Fax:210-930-5513
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6199OtherBLUE CROSS/SHIELD