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General NPI Number Information
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NPI Number | 1679896831
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Entity Type | Organization
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Legal Business Name | RENEW PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 2233 S KANAWHA ST
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City | BECKLEY
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State | WV
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Zip | 25801-6719
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Country | US
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Telephone | 304-255-9248
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Fax | 304-255-7595
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Provider Business Mailing Address
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Address Line | 2233 S KANAWHA ST P.O. BOX 9006
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City | BECKLEY
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State | WV
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Zip | 25801-6719
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Country | US
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Telephone | 304-255-9248
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Fax | 304-255-7595
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. DEE-DEE DANIEL
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Credential | DPT
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Telephone | 304-253-6686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 000323
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License Number State | WV
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