Provider Demographics
NPI:1417053083
Name:RENDIG, JOHN (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RENDIG
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 1:8525 N CEDAR AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4833
Mailing Address - Country:US
Mailing Address - Phone:559-440-9200
Mailing Address - Fax:559-440-9222
Practice Address - Street 1:8525 N CEDAR AVE STE 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-4833
Practice Address - Country:US
Practice Address - Phone:559-440-9200
Practice Address - Fax:599-440-9222
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29065ZMedicare ID - Type Unspecified