Provider Demographics
NPI:1174633382
Name:RENNINGER, PHILLIP (MPT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:RENNINGER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E WHIDBEY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5922
Mailing Address - Country:US
Mailing Address - Phone:360-675-9030
Mailing Address - Fax:360-675-2204
Practice Address - Street 1:520 E WHIDBEY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5922
Practice Address - Country:US
Practice Address - Phone:360-675-9030
Practice Address - Fax:360-675-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA77692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic