Provider Demographics
NPI:1134525389
Name:RENUE PHYSICAL THERAPY
Entity type:Organization
Organization Name:RENUE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-295-4844
Mailing Address - Street 1:1607 MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4179
Mailing Address - Country:US
Mailing Address - Phone:989-295-4844
Mailing Address - Fax:
Practice Address - Street 1:1607 MARQUETTE ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4179
Practice Address - Country:US
Practice Address - Phone:989-295-4844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENUE PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1871835405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty