=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225928252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEURORENEW PHYSICAL THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2025
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 ORTEGA ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-504-6045
-----------------------------------------------------
Fax | 415-712-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 ORTEGA ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-504-6045
-----------------------------------------------------
Fax | 415-712-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH POPOLIZIO
-----------------------------------------------------
Credential | PT, DPT, NCS
-----------------------------------------------------
Telephone | 408-504-6045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------