Healthcare Provider Details

I. General information

NPI: 1871403022
Provider Name (Legal Business Name): KATERINA RENUSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23715 LITTLE MACK AVE
SAINT CLAIR SHORES MI
48080-1181
US

IV. Provider business mailing address

23715 LITTLE MACK AVE
SAINT CLAIR SHORES MI
48080-1181
US

V. Phone/Fax

Practice location:
  • Phone: 586-447-4070
  • Fax: 586-447-4080
Mailing address:
  • Phone: 586-447-4070
  • Fax: 586-447-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304299
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: