Provider Demographics
NPI:1912147182
Name:RENEWAL BODYWORKS LLC
Entity Type:Organization
Organization Name:RENEWAL BODYWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-382-6343
Mailing Address - Street 1:2935 FREMONT AVE S
Mailing Address - Street 2:#401
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2085
Mailing Address - Country:US
Mailing Address - Phone:612-382-6343
Mailing Address - Fax:
Practice Address - Street 1:2935 FREMONT AVE S
Practice Address - Street 2:#401
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2085
Practice Address - Country:US
Practice Address - Phone:612-382-6343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty