Provider Demographics
NPI:1528139300
Name:RENTOY, PIA S (PT)
Entity type:Individual
Prefix:
First Name:PIA
Middle Name:S
Last Name:RENTOY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4152
Mailing Address - Country:US
Mailing Address - Phone:904-269-2437
Mailing Address - Fax:904-264-3497
Practice Address - Street 1:1218 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4152
Practice Address - Country:US
Practice Address - Phone:904-269-2437
Practice Address - Fax:904-264-3497
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY037SOtherBCBS
FLY037SOtherBCBS