Provider Demographics
NPI:1275063075
Name:ANDERSON, RENEE ELIZABETH (DPT)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:ELIZABETH
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2513 ANNABELLE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3915
Mailing Address - Country:US
Mailing Address - Phone:402-889-3720
Mailing Address - Fax:
Practice Address - Street 1:4831 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2704
Practice Address - Country:US
Practice Address - Phone:402-502-1819
Practice Address - Fax:402-315-9994
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist