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General NPI Number Information
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NPI Number | 1619634789
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Entity Type | Organization
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Legal Business Name | RENEGADE WAREHOUSE
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 10841 WOOD RD
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City | MIAMISBURG
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State | OH
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Zip | 45342
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Country | US
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Telephone | 937-694-6226
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 DECKER DR
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City | MIAMISBURG
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State | OH
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Zip | 45342-6415
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Country | US
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Telephone | 937-694-6226
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Fax |
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Authorized Official
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Title or Position | HEAD OWNER
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Name | MRS. CHELSEA MARIE MUNCY
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Credential | PTA
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Telephone | 937-694-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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