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General NPI Number Information
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NPI Number | 1861948739
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Entity Type | Organization
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Legal Business Name | RENEU PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 06/04/2022
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Provider Practice Location Address
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Address Line | 101 LAKE ST W STE 210
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City | WAYZATA
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State | MN
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Zip | 55391-1578
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Country | US
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Telephone | 612-562-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 2608 CLOVER FIELD CIR
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City | CHASKA
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State | MN
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Zip | 55318-3233
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Country | US
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Telephone | 612-860-6525
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Fax |
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Authorized Official
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Title or Position | OWNER, PT
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Name | NATALIE MARIE MILLER
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Credential | PT, DPT, OCS
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Telephone | 612-860-6525
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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 | 8820
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License Number State | MN
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