Provider Demographics
NPI:1417255183
Name:RENEW PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RENEW PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLIE
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:CASH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:205-335-4456
Mailing Address - Street 1:10452 HIGHWAY 5
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRENT
Mailing Address - State:AL
Mailing Address - Zip Code:35034-3923
Mailing Address - Country:US
Mailing Address - Phone:205-335-4456
Mailing Address - Fax:
Practice Address - Street 1:10452 HIGHWAY 5
Practice Address - Street 2:SUITE D
Practice Address - City:BRENT
Practice Address - State:AL
Practice Address - Zip Code:35034-3923
Practice Address - Country:US
Practice Address - Phone:205-335-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty