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General NPI Number Information
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NPI Number | 1114371358
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Entity Type | Organization
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Legal Business Name | RENEW PHYSICAL THERAPY & WELLNESS STUDIO
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 1630 MINERAL SPRING AVE STE 6-7
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4043
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Country | US
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Telephone | 401-400-5282
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 MINERAL SPRING AVE STE 6-7
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4043
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Country | US
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Telephone | 401-400-5282
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAVID CALCATTI
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Credential |
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Telephone | 401-952-8392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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