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NPI Code Detail

MEDICARE: AMY LYNN RENZONI PTA

MEDICARE: AMY LYNN RENZONI PTA
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
1225200000XPhysical Therapy Assistant1003-019WI

General Provider Information

NPI Number : 1518132414
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LYNN RENZONI PTA
Provider Business Mailing Address
First Line : 3100 WASHINGTON RD
Second Line :
City : KENOSHA
State : WI
Zip : 53144-1604
Country : US
Telephone Number : 262-658-4074
Fax Number :
Provider Business Practice Location Address
First Line : 3100 WASHINGTON RD
Second Line :
City : KENOSHA
State : WI
Zip : 53144-1604
Country : US
Telephone Number : 262-658-4074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2008
Last Update Date : 04/23/2008

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