Renegade Movement and Performance, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

RENEGADE MOVEMENT AND PERFORMANCE, LLC

Practice address

10 Commerce Park N Ste 7B
Bedford, NH 03110-6907

Phone

(603) 267-0432

NPI assigned

Jul 6, 2020

Organization subpart

No

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

Authorized official

Name

Alexis Brunelle, PT, DPT

Title

Physical Therapist, Co-Owner

Phone

(315) 573-0705

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle Paul Brunelle, PT, DPT

  • Physical Therapist
  • Bedford, NH
  • NPI 1821649922
  NPD

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

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655251200000",
    "number": "1770100893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 MCGREGOR ST APT 414",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031023777",
            "telephone_number": "315-573-0705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 COMMERCE PARK N STE 7B",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031106907",
            "telephone_number": "603-267-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEGADE MOVEMENT AND PERFORMANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-06",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A",
        "authorized_official_last_name": "BRUNELLE",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, CO-OWNER",
        "authorized_official_telephone_number": "315-573-0705",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Bedford, NH
• Providers in Bedford, NH by specialty
• Physical Therapy Clinic/Center in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.