Provider Demographics
NPI:1689231243
Name:RENNER, TERESA MARIE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:RENNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 CANYON DE FLORES STE B
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-5380
Mailing Address - Country:US
Mailing Address - Phone:520-803-9727
Mailing Address - Fax:520-378-2683
Practice Address - Street 1:3455 CANYON DE FLORES STE B
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-5380
Practice Address - Country:US
Practice Address - Phone:520-803-9727
Practice Address - Fax:520-378-2683
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist