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General NPI Number Information
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NPI Number | 1073920559
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Entity Type | Individual
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Provider Name | MICHAEL RENFRO AT-C, MA
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Gender | Male
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 5701 STILLWATER BLVD N
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City | OAK PARK HEIGHTS
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State | MN
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Zip | 55082-1030
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Country | US
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Telephone | 651-351-8034
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 COLONIAL DR
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City | HUDSON
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State | WI
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Zip | 54016-1938
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Country | US
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Telephone | 727-776-5153
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1517
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License Number State | SC
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