Provider Demographics
NPI:1164980272
Name:RENZLER, KERI (MS, LAT, ATC, CES)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:RENZLER
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-1402
Mailing Address - Country:US
Mailing Address - Phone:740-338-7645
Mailing Address - Fax:
Practice Address - Street 1:2704 WHITE PINE WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7462
Practice Address - Country:US
Practice Address - Phone:740-338-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer