Provider Demographics
NPI:1033229067
Name:RENEWAL REHABILITATION, INC.
Entity Type:Organization
Organization Name:RENEWAL REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANASTASAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-254-9475
Mailing Address - Street 1:613 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2767
Mailing Address - Country:US
Mailing Address - Phone:813-254-9475
Mailing Address - Fax:813-251-0460
Practice Address - Street 1:613 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2767
Practice Address - Country:US
Practice Address - Phone:813-254-9475
Practice Address - Fax:813-251-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106852Medicare ID - Type UnspecifiedMCARE PROV#