# RENEGADE MOVEMENT AND PERFORMANCE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770100893
- **Authorized official:** ALEXIS BRUNELLE PT, DPT (PHYSICAL THERAPIST, CO-OWNER)
- **Authorized official phone:** (315) 573-0705

## Contact information

- **Practice address:** 10 COMMERCE PARK N STE 7B, BEDFORD, NH 03110-6907
- **Practice address phone:** (603) 267-0432
- **Mailing address:** 195 MCGREGOR ST APT 414, MANCHESTER, NH 03102-3777
- **Mailing address phone:** (315) 573-0705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/06/2020
- **Last updated:** 06/15/2022