Active NPI
Ryan Patrick Renkiewicz, ATC
- Athletic Trainer
- Roy, UT
National Provider Identifier
1093329948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 8081236-4810
- Practice address
- 2150 W 4800 S
Roy, UT 84067-1844 - Phone
- (801) 476-3600
- NPI assigned
- Sep 8, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 8081236-4810 | UT | Primary |
Addresses
Primary practice location
2150 W 4800 S
Roy, UT 84067-1844
Mailing address
5890 S 4550 W
Hooper, UT 84315-6771
Phone (231) 920-0924
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8081236-4810 | UT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599523200000",
"number": "1093329948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5890 S 4550 W",
"city": "HOOPER",
"state": "UT",
"postal_code": "843156771",
"telephone_number": "231-920-0924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2150 W 4800 S",
"city": "ROY",
"state": "UT",
"postal_code": "840671844",
"telephone_number": "801-476-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENKIEWICZ",
"first_name": "RYAN",
"middle_name": "PATRICK",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-08",
"last_updated": "2020-09-08",
"certification_date": "2020-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "UT",
"license": "8081236-4810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roy, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.