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General NPI Number Information
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NPI Number | 1396770400
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Entity Type | Organization
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Legal Business Name | RENAISSANCE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30200 SCHOENHERR
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-775-5267
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Fax | 586-775-2331
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Provider Business Mailing Address
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Address Line | 30020 SCHOENHERR
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-775-5267
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Fax | 586-775-2331
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAHAT MALIK
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Credential |
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Telephone | 586-775-5267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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