Provider Demographics
NPI:1568764637
Name:RENAUT, ELIZABETH HOLMES (PT, LDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HOLMES
Last Name:RENAUT
Suffix:
Gender:F
Credentials:PT, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 BRASSIE CT
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-3110
Mailing Address - Country:US
Mailing Address - Phone:443-994-5931
Mailing Address - Fax:
Practice Address - Street 1:1109 BRASSIE CT
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-3110
Practice Address - Country:US
Practice Address - Phone:443-994-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3700133N00000X
MD23345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist