Healthcare Provider Details

I. General information

NPI: 1932426426
Provider Name (Legal Business Name): LYNN RENWICK LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E MAPLE ST
NORTH CANTON OH
44720
US

IV. Provider business mailing address

281 ORANGEVILLE RD
GREENVILLE PA
16125-9215
US

V. Phone/Fax

Practice location:
  • Phone: 330-498-8200
  • Fax:
Mailing address:
  • Phone: 724-988-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 7521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: