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General NPI Number Information
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NPI Number | 1972092989
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Entity Type | Organization
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Legal Business Name | RENEW PHYSICAL THERAPY AND WELLNESS, LLC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | N2919 COUNTY ROAD QQ
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City | WAUPACA
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State | WI
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Zip | 54981
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Country | US
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Telephone | 763-228-2755
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Fax |
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Provider Business Mailing Address
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Address Line | 128 5TH AVE N
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City | JUNCTION CITY
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State | WI
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Zip | 54443-9411
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Country | US
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Telephone | 763-228-2755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY A JOHNSON
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Credential |
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Telephone | 763-228-2755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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