Provider Demographics
NPI:1164578035
Name:RENOVATIO PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:RENOVATIO PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEBITA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-882-6000
Mailing Address - Street 1:191 NORTH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1510
Mailing Address - Country:US
Mailing Address - Phone:716-882-6000
Mailing Address - Fax:
Practice Address - Street 1:191 NORTH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1510
Practice Address - Country:US
Practice Address - Phone:716-882-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty