Healthcare Provider Details

I. General information

NPI: 1518875061
Provider Name (Legal Business Name): RENAISSANCE PM&R SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 VISTA RD
FORT MILL SC
29708-7800
US

IV. Provider business mailing address

885 GOLD HILL RD
FORT MILL SC
29708-7946
US

V. Phone/Fax

Practice location:
  • Phone: 802-735-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEVIN ESTES
Title or Position: DO/OWNER
Credential: DO
Phone: 203-829-3370