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General NPI Number Information
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NPI Number | 1407105794
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Entity Type | Organization
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Legal Business Name | RENAISSANCE HOME THERAPY INC
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Dates
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Enumeration Date | 09/03/2012
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Last Update Date | 09/03/2012
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Provider Practice Location Address
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Address Line | 116 CANAL ST SUITE D
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7098
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Country | US
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Telephone | 386-426-8327
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Fax |
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Provider Business Mailing Address
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Address Line | 116 CANAL ST SUITE D
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7098
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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 | PRESIDENT
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Name | MR. EVERETT WEIGHTMAN
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Credential |
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Telephone | 386-426-8327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | P12000069271
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License Number State | FL
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