Healthcare Provider Details

I. General information

NPI: 1295213478
Provider Name (Legal Business Name): MEGAN ELIZABETH RENNIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18650 NW CORNELL RD STE 314
HILLSBORO OR
97124-9212
US

IV. Provider business mailing address

17340 SW JAY ST APT 202
BEAVERTON OR
97003-7651
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-9760
  • Fax:
Mailing address:
  • Phone: 406-461-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number61053
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: