Provider Demographics
NPI:1033661046
Name:RENEWAL REHABILITATION INC
Entity Type:Organization
Organization Name:RENEWAL REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, CSCS
Authorized Official - Phone:813-907-0430
Mailing Address - Street 1:613 S MAGNOLIA AVE
Mailing Address - Street 2:SUITE 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:
Practice Address - Street 1:613 S MAGNOLIA AVE
Practice Address - Street 2:SUITE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4154251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare