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General NPI Number Information
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NPI Number | 1366260473
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Entity Type | Organization
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Legal Business Name | RENEW WELLNESS INC
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Dates
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Enumeration Date | 09/27/2024
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 234 CROSSWAYS PARK DR
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City | WOODBURY
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State | NY
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Zip | 11797-2015
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Country | US
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Telephone | 516-477-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 2 ALLENBY DR
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City | NORTHPORT
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State | NY
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Zip | 11768-1421
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Country | US
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Telephone | 516-477-8003
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEIDI DAWN DIETL
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Credential | LMT
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Telephone | 516-477-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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