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General NPI Number Information
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NPI Number | 1164980272
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Entity Type | Individual
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Provider Name | KERI RENZLER MS, LAT, ATC, CES
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Gender | Female
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 2704 WHITE PINE WAY
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-7462
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Country | US
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Telephone | 740-338-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 7 BROOKSIDE AVE
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City | BRIDGEPORT
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State | OH
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Zip | 43912-1402
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Country | US
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Telephone | 740-338-7645
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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 |
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License Number State |
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