Healthcare Provider Details

I. General information

NPI: 1720633191
Provider Name (Legal Business Name): MK RENNER PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W BANGALOR DR
ORO VALLEY AZ
85737-5030
US

IV. Provider business mailing address

625 W BANGALOR DR
ORO VALLEY AZ
85737-5030
US

V. Phone/Fax

Practice location:
  • Phone: 520-247-7420
  • Fax:
Mailing address:
  • Phone: 520-247-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MELANI BYRNES
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT, DPT
Phone: 520-247-7420