MEDICARE: RENEWAL SKIN SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1184942476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWAL SKIN SOLUTIONS

Provider Business Mailing Address
First Line	:	457 VISTA DR
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1360
Country	:	US
Telephone Number	:	931-738-3383
Fax Number	:	931-738-8911

Provider Business Practice Location Address
First Line	:	453 VISTA DR
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1360
Country	:	US
Telephone Number	:	931-738-3383
Fax Number	:	913-738-8911

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. MISCHELLE L FERRELL
Credential	:	MHA
Telephone Number	:	931-738-3383

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	05/11/2010

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Directions to “RENEWAL SKIN SOLUTIONS ” Practice Location

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