Provider Demographics
NPI:1760476204
Name:RENSHAW, CHARA M (PT)
Entity Type:Individual
Prefix:
First Name:CHARA
Middle Name:M
Last Name:RENSHAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHARA
Other - Middle Name:M
Other - Last Name:CHOCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:LUTHER
Mailing Address - State:OK
Mailing Address - Zip Code:73054-0693
Mailing Address - Country:US
Mailing Address - Phone:405-246-0044
Mailing Address - Fax:405-246-0040
Practice Address - Street 1:1800 RENAISSANCE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3023
Practice Address - Country:US
Practice Address - Phone:405-246-0044
Practice Address - Fax:405-246-0040
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10628225100000X
OKPT3733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCO306628Medicare UPIN