Healthcare Provider Details

I. General information

NPI: 1023245826
Provider Name (Legal Business Name): VIRGINIA GOLLOWAY RENEGAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HECKEL RD
MC KEES ROCKS PA
15136-1652
US

IV. Provider business mailing address

1638 TIFFANY RDG
PITTSBURGH PA
15241-3236
US

V. Phone/Fax

Practice location:
  • Phone: 412-777-6231
  • Fax: 412-777-6528
Mailing address:
  • Phone: 412-777-6231
  • Fax: 412-777-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011539L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: