Healthcare Provider Details

I. General information

NPI: 1114443876
Provider Name (Legal Business Name): RENEWED PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17557 CLARIDGE OVAL W
BOCA RATON FL
33496-1336
US

IV. Provider business mailing address

11950 NW 6TH ST
PLANTATION FL
33325-1800
US

V. Phone/Fax

Practice location:
  • Phone: 954-609-6432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD EVANS
Title or Position: PRESIDENT
Credential: PT
Phone: 954-475-9734