Provider Demographics
NPI:1720581564
Name:RENEWED STRENGTH PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:RENEWED STRENGTH PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STELLATO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-375-3761
Mailing Address - Street 1:416 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5225
Mailing Address - Country:US
Mailing Address - Phone:516-375-3761
Mailing Address - Fax:
Practice Address - Street 1:416 NEVADA ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5225
Practice Address - Country:US
Practice Address - Phone:516-375-3761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty