MEDICARE: RENEW PHYSICAL THERAPY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1053391821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	568 20TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1006
Country	:	US
Telephone Number	:	718-398-9762
Fax Number	:

Provider Business Practice Location Address
First Line	:	568 20TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1006
Country	:	US
Telephone Number	:	718-398-9762
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH HERRERA
Credential	:	PT
Telephone Number	:	718-398-9762

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	08/22/2020

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