Provider Demographics
NPI:1932878485
Name:TARLTON, RENEE ANN (PT, MSPT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN
Last Name:TARLTON
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4649
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-0054
Mailing Address - Country:US
Mailing Address - Phone:512-267-5400
Mailing Address - Fax:512-267-5700
Practice Address - Street 1:5802 THUNDERBIRD APT A
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-5888
Practice Address - Country:US
Practice Address - Phone:512-267-5400
Practice Address - Fax:512-267-5700
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist