Individual provider Active NPI

John Raymond Reneau, MS,PT,OCS,ATC,LAT

  • Physical Therapist
  • Wichita Falls, TX
National Provider Identifier
1174553317
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1068286 Issued in TX
Practice address
2500 Kemp Blvd
Wichita Falls, TX 76309-5347
Phone
(940) 687-3422
Fax
(940) 687-0726
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1068286 TX Primary

Addresses

Primary practice location

2500 Kemp Blvd
Wichita Falls, TX 76309-5347

Mailing address

2500 Kemp Blvd
Wichita Falls, TX 76309-5347
Phone (940) 687-3422

Other identifiers 1

IdentifierTypeStateIssuer
156913901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120502000714 TX Practitioner - Physical Therapist in Private Practice 5193800290 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reneau Rehab IncGroup PAC ID 2365527645, 5 clinicians

Practice addresses (Care Compare)

2500 Kemp Blvd
Wichita Falls, TX 76309-5347
Phone (940) 687-3422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
2584OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Helen Farabee Centers CurrentSince Feb 1, 2018 Accepting new patients
Reneau Rehab Inc Physical Therapist CurrentSince Dec 1, 2002 Accepting new patients
H2 Rehabilitation Services of Lawton LP Physical Therapist CurrentSince Feb 1, 2023 Accepting new patients
Reneau Rehab Inc Physical Therapist CurrentSince Dec 1, 2002 Accepting new patients
H2 Rehabilitation Services of Mustang LP Physical Therapist CurrentSince May 1, 2023 Accepting new patients

Locations

404 S Elm St
Ste 112
Jenks, OK 74037
Phone (240) 858-1654

916 SW 38th St
Ste C
Lawton, OK 73505
Phone (580) 353-1490

1337 E State Highway 152
Ste 111
Mustang, OK 73064
Phone (405) 745-4786

3146 E 11th St
Tulsa, OK 74104
Phone (918) 727-2272

208 S Red River Expy
Burkburnett, TX 76354
Phone (940) 569-3630

2500 Kemp Blvd
Wichita Falls, TX 76309
Phone (940) 687-3422

500 Broad St
Wichita Falls, TX 76301
Phone (940) 397-3300

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421712000000",
    "number": "1174553317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 KEMP BLVD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763095347",
            "telephone_number": "940-687-3422",
            "fax_number": "940-687-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 KEMP BLVD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763095347",
            "telephone_number": "940-687-3422",
            "fax_number": "940-687-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENEAU",
        "first_name": "JOHN",
        "middle_name": "RAYMOND",
        "name_prefix": "Mr.",
        "credential": "MS,PT,OCS,ATC,LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2015-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1068286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156913901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.