Provider Demographics
NPI:1750729455
Name:HENNEL-FLESHMAN, RENEE L (PT)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:L
Last Name:HENNEL-FLESHMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MEADOW SPRING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-7311
Mailing Address - Country:US
Mailing Address - Phone:636-485-6098
Mailing Address - Fax:
Practice Address - Street 1:37 MEADOW SPRING DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-7311
Practice Address - Country:US
Practice Address - Phone:636-485-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist