Provider Demographics
NPI:1104583822
Name:RENSHAW, CARLA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:RENSHAW
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 N STATE HIGHWAY H
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-7137
Mailing Address - Country:US
Mailing Address - Phone:417-241-8808
Mailing Address - Fax:
Practice Address - Street 1:3761 N STATE HIGHWAY H
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-7137
Practice Address - Country:US
Practice Address - Phone:417-351-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005006915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty