Provider Demographics
NPI:1053884668
Name:RENTFROW, JULIA YVONNE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:YVONNE
Last Name:RENTFROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FIR ST
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-2761
Mailing Address - Country:US
Mailing Address - Phone:276-690-5896
Mailing Address - Fax:
Practice Address - Street 1:330 FIR ST
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-2761
Practice Address - Country:US
Practice Address - Phone:276-690-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT65013335347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5896Medicaid