Provider Demographics
NPI:1801402953
Name:RENNER, KAREN (ATC, PTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:RENNER
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4852 S MANNING RD
Mailing Address - Street 2:
Mailing Address - City:HOLLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14470-9042
Mailing Address - Country:US
Mailing Address - Phone:585-749-3581
Mailing Address - Fax:
Practice Address - Street 1:2300 BUFFALO RD BLDG 300A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1369
Practice Address - Country:US
Practice Address - Phone:585-247-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0010252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer