MEDICARE: ANNETTE RENN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070015006	IL

General Provider Information

NPI Number	:	1205970035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE RENN DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 SILVER CROSS BLVD STE 200
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-8646
Country	:	US
Telephone Number	:	815-463-5324
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	03/09/2015

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Directions to “ ANNETTE RENN DPT” Practice Location

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