Provider Demographics
NPI:1164591921
Name:RENARD, RONALD (PT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:RENARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 BERRYWOOD DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6517
Mailing Address - Country:US
Mailing Address - Phone:573-449-8771
Mailing Address - Fax:
Practice Address - Street 1:941 CHEROKEE DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3646
Practice Address - Country:US
Practice Address - Phone:660-831-1895
Practice Address - Fax:660-831-1898
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101983OtherLICENSE#