Provider Demographics
NPI:1790394930
Name:RENEWED MOVEMENT
Entity Type:Organization
Organization Name:RENEWED MOVEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:181-595-4765
Mailing Address - Street 1:24507 W 79TH CT
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-2815
Mailing Address - Country:US
Mailing Address - Phone:181-595-4765
Mailing Address - Fax:
Practice Address - Street 1:24507 W 79TH CT
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-2815
Practice Address - Country:US
Practice Address - Phone:181-595-4765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty