Provider Demographics
NPI:1376315309
Name:RENEW PHYSICAL THERAPY WELLNESS
Entity Type:Organization
Organization Name:RENEW PHYSICAL THERAPY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TRESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DOT
Authorized Official - Phone:319-383-3215
Mailing Address - Street 1:693 49TH ST.
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302
Mailing Address - Country:US
Mailing Address - Phone:319-326-1664
Mailing Address - Fax:
Practice Address - Street 1:693 49TH ST.
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302
Practice Address - Country:US
Practice Address - Phone:319-326-1664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy