Provider Demographics
NPI:1205038759
Name:RENNELLS, ANN LOUISE-TARDANI (PT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE-TARDANI
Last Name:RENNELLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3125
Mailing Address - Country:US
Mailing Address - Phone:231-759-0760
Mailing Address - Fax:
Practice Address - Street 1:885 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4023
Practice Address - Country:US
Practice Address - Phone:231-733-1615
Practice Address - Fax:231-733-7815
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist