MEDICARE: DUSTIN D RENAUD PT

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	PT01590	RI

General Provider Information

NPI Number	:	1861427064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN D RENAUD PT

Provider Business Mailing Address
First Line	:	1140 MENDON ROAD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864
Country	:	US
Telephone Number	:	401-333-9787
Fax Number	:	401-333-9785

Provider Business Practice Location Address
First Line	:	1140 MENDON ROAD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864
Country	:	US
Telephone Number	:	401-333-9787
Fax Number	:	401-333-9785

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	12/12/2025

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