Provider Demographics
NPI:1538125554
Name:BOMAR, RENAE ELLEN (EDD, ATC, SCAT)
Entity Type:Individual
Prefix:DR
First Name:RENAE
Middle Name:ELLEN
Last Name:BOMAR
Suffix:
Gender:F
Credentials:EDD, ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BERTRAM RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8393
Mailing Address - Country:US
Mailing Address - Phone:812-878-0923
Mailing Address - Fax:
Practice Address - Street 1:9200 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9121
Practice Address - Country:US
Practice Address - Phone:812-878-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001019A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer