Individual
RENE RILLORTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3415 SHERIDAN RD, KENOSHA, WI 53140-1924
(262) 657-6681
Mailing address
3415 SHERIDAN RD, KENOSHA, WI 53140-1924
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10208
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40442900
—
WI
Enumeration date
05/05/2008
Last updated
05/05/2008
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