Provider Demographics
NPI:1821681792
Name:RENEWED PERFORMANCE, LLC
Entity Type:Organization
Organization Name:RENEWED PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDKIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:270-557-2121
Mailing Address - Street 1:2190 NEW HOLT RD STE A
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8929
Mailing Address - Country:US
Mailing Address - Phone:270-557-2121
Mailing Address - Fax:270-557-2123
Practice Address - Street 1:2190 NEW HOLT RD STE A
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8929
Practice Address - Country:US
Practice Address - Phone:270-557-2121
Practice Address - Fax:270-557-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy