Provider Demographics
NPI:1508547639
Name:RENEW SPINE & REHAB PLLC
Entity Type:Organization
Organization Name:RENEW SPINE & REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-646-3100
Mailing Address - Street 1:26865 INTERSTATE 45 STE 300
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4046
Mailing Address - Country:US
Mailing Address - Phone:346-646-3100
Mailing Address - Fax:
Practice Address - Street 1:456 PARK GROVE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1571
Practice Address - Country:US
Practice Address - Phone:346-646-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty