MEDICARE: RENEW PHYSICAL THERAPY GROUP PC

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	225100000X	Physical Therapist
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1376229518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW PHYSICAL THERAPY GROUP PC

Provider Business Mailing Address
First Line	:	8213 S VAN NESS AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-1545
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S BEVERLY DR STE 360
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4405
Country	:	US
Telephone Number	:	909-992-9820
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CYNTHIA GLASER
Credential	:	PT, DPT, OCS
Telephone Number	:	909-992-9820

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	06/23/2023

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