Provider Demographics
NPI:1114371358
Name:RENEW PHYSICAL THERAPY & WELLNESS STUDIO
Entity Type:Organization
Organization Name:RENEW PHYSICAL THERAPY & WELLNESS STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CALCATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-952-8392
Mailing Address - Street 1:1630 MINERAL SPRING AVE STE 6-7
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4043
Mailing Address - Country:US
Mailing Address - Phone:401-400-5282
Mailing Address - Fax:
Practice Address - Street 1:1630 MINERAL SPRING AVE STE 6-7
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4043
Practice Address - Country:US
Practice Address - Phone:401-400-5282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty