Provider Demographics
NPI:1043817133
Name:RENO, BOBBY A (PTA)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:A
Last Name:RENO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-9301
Mailing Address - Country:US
Mailing Address - Phone:352-674-4800
Mailing Address - Fax:
Practice Address - Street 1:4380 SW 62ND LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-2708
Practice Address - Country:US
Practice Address - Phone:352-572-5937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24661225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant