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General NPI Number Information
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NPI Number | 1801402953
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Entity Type | Individual
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Provider Name | KAREN RENNER ATC, PTA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 2300 BUFFALO RD BLDG 300A
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City | ROCHESTER
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State | NY
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Zip | 14624-1369
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Country | US
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Telephone | 585-247-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 4852 S MANNING RD
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City | HOLLEY
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State | NY
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Zip | 14470-9042
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Country | US
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Telephone | 585-749-3581
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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 | 001025
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License Number State | NY
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