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General NPI Number Information
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NPI Number | 1699967992
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Entity Type | Organization
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Legal Business Name | RENEW PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 19345 SUNSHINE AVENUE
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City | COVINGTON
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State | LA
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Zip | 70433
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Country | US
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Telephone | 985-809-3940
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Fax | 985-809-3942
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Provider Business Mailing Address
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Address Line | 19345 SUNSHINE AVENUE SUITE A
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City | COVINGTON
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State | LA
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Zip | 70433-8720
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Country | US
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Telephone | 985-809-3940
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Fax | 985-809-3942
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. VICTOR J VARISCO
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Credential | O.T.
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Telephone | 337-233-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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