Healthcare Provider Details

I. General information

NPI: 1326206277
Provider Name (Legal Business Name): ANDREA LYNN RENSHAW MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 TIMBERLINE RD SUITE 110
HIGHLANDS RANCH CO
80130-5345
US

IV. Provider business mailing address

6660 TIMBERLINE RD SUITE 110
HIGHLANDS RANCH CO
80130-5345
US

V. Phone/Fax

Practice location:
  • Phone: 303-683-4500
  • Fax: 303-683-4515
Mailing address:
  • Phone: 303-683-4500
  • Fax: 303-683-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6648
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: