Provider Demographics
NPI:1568804565
Name:RENAUD, NICOLE HELEN (DPT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:HELEN
Last Name:RENAUD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4090
Mailing Address - Country:US
Mailing Address - Phone:719-632-6818
Mailing Address - Fax:719-632-6821
Practice Address - Street 1:3470 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4090
Practice Address - Country:US
Practice Address - Phone:719-632-6818
Practice Address - Fax:719-632-6821
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66123275Medicaid
COORF066563Medicare Oscar/Certification