Provider Demographics
NPI:1780735522
Name:RENNELL, JAMES (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:RENNELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 FLINTRIDGE DR
Mailing Address - Street 2:LEGACY REHABILITAION
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1883
Mailing Address - Country:US
Mailing Address - Phone:719-599-7328
Mailing Address - Fax:719-264-0227
Practice Address - Street 1:5820 FLINTRIDGE DR.
Practice Address - Street 2:LEGACY REHABILITATION
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6901
Practice Address - Country:US
Practice Address - Phone:719-599-7328
Practice Address - Fax:719-264-0227
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist