Provider Demographics
NPI:1679896831
Name:RENEW PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:RENEW PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE-DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:304-253-6686
Mailing Address - Street 1:2233 S KANAWHA ST
Mailing Address - Street 2:P.O. BOX 9006
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6719
Mailing Address - Country:US
Mailing Address - Phone:304-255-9248
Mailing Address - Fax:304-255-7595
Practice Address - Street 1:2233 S KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6719
Practice Address - Country:US
Practice Address - Phone:304-255-9248
Practice Address - Fax:304-255-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT 000323261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy