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General NPI Number Information
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NPI Number | 1639834377
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Entity Type | Organization
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Legal Business Name | RENAISSANCE INTERNATIONAL CORP.
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 10 PRINCE PL STE 112
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City | NEWBURYPORT
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State | MA
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Zip | 01950-2641
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Country | US
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Telephone | 978-465-5111
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Fax | 206-202-3534
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Provider Business Mailing Address
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Address Line | 204 HIGH ST
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3824
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Country | US
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Telephone | 978-465-5111
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Fax | 206-202-3534
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Authorized Official
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Title or Position | PRESIDENT
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Name | E ROBERT KELLER II
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Credential | BCTMB
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Telephone | 978-465-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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