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General NPI Number Information
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NPI Number | 1063987501
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Entity Type | Organization
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Legal Business Name | RENEWED LIFESTYLES INC
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 402 GREENBELT DR
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City | MARYVILLE
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State | TN
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Zip | 37804-5702
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Country | US
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Telephone | 865-271-8241
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Fax |
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Provider Business Mailing Address
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Address Line | 402 GREENBELT DR
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City | MARYVILLE
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State | TN
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Zip | 37804-5702
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSCIAN
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Name | DAVID TERRY
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Credential |
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Telephone | 865-271-8241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QL0400X
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Taxonomy Name | Lithotripsy Clinic/Center
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License Number |
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License Number State |
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