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General NPI Number Information
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NPI Number | 1689924680
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Entity Type | Individual
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Provider Name | RENEE PEDERSEN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 1401 S. CALIFORNIA BLVD.
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City | CHICAGO
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State | IL
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Zip | 60608
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Country | US
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Telephone | 773-522-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 S. CALIFORNIA BLVD.
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City | CHICAGO
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State | IL
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Zip | 60608
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 297988
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT38966
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10064
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.018745
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License Number State | IL
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