Provider Demographics
NPI:1538568191
Name:RENNALLS, MARQUI (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:MARQUI
Middle Name:
Last Name:RENNALLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5661 3RD ST NE APT 460
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2573
Mailing Address - Country:US
Mailing Address - Phone:914-557-4416
Mailing Address - Fax:
Practice Address - Street 1:5661 3RD ST NE APT 460
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2573
Practice Address - Country:US
Practice Address - Phone:914-557-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0378281225100000X
DCPT872667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist