Healthcare Provider Details

I. General information

NPI: 1184942476
Provider Name (Legal Business Name): RENEWAL SKIN SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 VISTA DR
SPARTA TN
38583-1360
US

IV. Provider business mailing address

457 VISTA DR
SPARTA TN
38583-1360
US

V. Phone/Fax

Practice location:
  • Phone: 931-738-3383
  • Fax: 913-738-8911
Mailing address:
  • Phone: 931-738-3383
  • Fax: 931-738-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. MISCHELLE L FERRELL
Title or Position: PRACTICE ADMINISTRATOR
Credential: MHA
Phone: 931-738-3383