Provider Demographics
NPI:1831294420
Name:RENNEKER, KRISTI (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:
Last Name:RENNEKER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GOODWIN CREST DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3701
Mailing Address - Country:US
Mailing Address - Phone:205-290-4550
Mailing Address - Fax:
Practice Address - Street 1:234 GOODWIN CREST DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3701
Practice Address - Country:US
Practice Address - Phone:205-290-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22062251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51536496OtherBCBS
AL890018760Medicaid