MEDICARE: RENUE 004 BRIDGEPORT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	261QP2000X	Physical Therapy Clinic/Center
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952740466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENUE 004 BRIDGEPORT, LLC

Provider Business Mailing Address
First Line	:	804 N WATER ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-5620
Country	:	US
Telephone Number	:	989-450-3341
Fax Number	:	989-778-1237

Provider Business Practice Location Address
First Line	:	5460 W. ROLLING HILLS DRIVE
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9668
Country	:	US
Telephone Number	:	989-928-1337
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY KLAPISH
Credential	:
Telephone Number	:	989-928-1337

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	06/17/2025

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