Healthcare Provider Details

I. General information

NPI: 1396205126
Provider Name (Legal Business Name): CARLOS LAMAR RENCHER JR. ATC, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 E BELL RD STE 150
PHOENIX AZ
85032-2239
US

IV. Provider business mailing address

15757 N 90TH PL APT 1005
SCOTTSDALE AZ
85260-2003
US

V. Phone/Fax

Practice location:
  • Phone: 216-744-6331
  • Fax:
Mailing address:
  • Phone: 216-744-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR-009354
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: