Provider Demographics
NPI:1861891533
Name:BLENMAN, RENEE (PTA)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:BLENMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3105 SIOUX DR
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-8224
Mailing Address - Country:US
Mailing Address - Phone:937-638-1574
Mailing Address - Fax:
Practice Address - Street 1:140 E WOODBURY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2841
Practice Address - Country:US
Practice Address - Phone:937-356-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08028225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant