Provider Demographics
NPI:1316057490
Name:RENTH, MICHELE LEE (PT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:RENTH
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LEE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:917 PHILLIP CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3101
Mailing Address - Country:US
Mailing Address - Phone:618-540-9885
Mailing Address - Fax:
Practice Address - Street 1:5900 N ILLINOIS
Practice Address - Street 2:SUITE 9
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208
Practice Address - Country:US
Practice Address - Phone:314-621-1416
Practice Address - Fax:618-624-9330
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.008243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist