Active NPI
Stacy Ann Renner, PT
- Physical Therapist
- Murray, UT
National Provider Identifier
1669554697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 360166-2401
- Practice address
- 5848 Fashion Blvd
Murray, UT 84107-6121 - Phone
- (801) 269-2696
- Fax
- (801) 269-2690
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 360166-2401 | UT | Primary |
Addresses
Primary practice location
5848 Fashion Blvd
Murray, UT 84107-6121
Mailing address
PO Box 27247
Salt Lake City, UT 84127-0247
Phone (801) 269-2696
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 360166-2401 | UT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669554697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27247",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841270247",
"telephone_number": "801-269-2696",
"fax_number": "801-269-2690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5848 FASHION BLVD",
"city": "MURRAY",
"state": "UT",
"postal_code": "841076121",
"telephone_number": "801-269-2696",
"fax_number": "801-269-2690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENNER",
"first_name": "STACY",
"middle_name": "ANN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "360166-2401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Murray, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.