Individual
JESSE RENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2404 N STOCKTON HILL RD STE K, KINGMAN, AZ 86401-4184
(928) 440-6880
(928) 529-5036
Mailing address
2404 N STOCKTON HILL RD STE K, KINGMAN, AZ 86401-4184
(928) 440-6880
(928) 529-5036
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
LPT-32584
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPT-32584
ARIZONA STATE BOARD OF PHYSICAL THERAPY
AZ
Enumeration date
09/29/2022
Last updated
09/29/2022
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