Healthcare Provider Details

I. General information

NPI: 1659103448
Provider Name (Legal Business Name): RENEWAL THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5036 TROUBLE CREEK RD
NEW PORT RICHEY FL
34652-4904
US

IV. Provider business mailing address

5036 TROUBLE CREEK RD
NEW PORT RICHEY FL
34652-4904
US

V. Phone/Fax

Practice location:
  • Phone: 813-735-4635
  • Fax:
Mailing address:
  • Phone: 813-735-4635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KARLA FRANCHESKA MIRANDA MEDINA
Title or Position: OWNER
Credential: MD
Phone: 787-435-5170