Healthcare Provider Details

I. General information

NPI: 1487680633
Provider Name (Legal Business Name): ANGELA MARIE RENNER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ANGELA MARIE ROHLING

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S 1ST AVE
BROKEN BOW NE
68822-2213
US

IV. Provider business mailing address

325 S 1ST AVE PO BOX 435
BROKEN BOW NE
68822-2213
US

V. Phone/Fax

Practice location:
  • Phone: 308-346-5111
  • Fax: 308-346-5111
Mailing address:
  • Phone: 308-872-5111
  • Fax: 308-872-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number102572 TEMP PT
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: