Provider Demographics
NPI:1407105794
Name:RENAISSANCE HOME THERAPY INC
Entity Type:Organization
Organization Name:RENAISSANCE HOME THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-426-8327
Mailing Address - Street 1:116 CANAL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 CANAL ST
Practice Address - Street 2:SUITE D
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7098
Practice Address - Country:US
Practice Address - Phone:386-426-8327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP12000069271251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health