Healthcare Provider Details

I. General information

NPI: 1245158971
Provider Name (Legal Business Name): RENSKE STRYDOM LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUBEN STRYDOM

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WHITLOCK AVE SW
MARIETTA GA
30064-1944
US

IV. Provider business mailing address

4641 FLINT HILL RD
AUSTELL GA
30106-1723
US

V. Phone/Fax

Practice location:
  • Phone: 770-966-2999
  • Fax:
Mailing address:
  • Phone: 770-966-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number014978
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: