Provider Demographics
NPI:1962427054
Name:HUMPHREY, RENEE C (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:C
Other - Last Name:BONIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:484 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:244 US HIGHWAY 68 E
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7568
Practice Address - Country:US
Practice Address - Phone:270-527-4322
Practice Address - Fax:270-252-7026
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004101A225100000X
KY008462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist