Healthcare Provider Details

I. General information

NPI: 1770402547
Provider Name (Legal Business Name): KARL ALEXANDER RENNALLS MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 SAN AMARO DR
CORAL GABLES FL
33146-2402
US

IV. Provider business mailing address

10835 SW 112TH AVE APT 118
MIAMI FL
33176-3230
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-4528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3715
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: