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NPI Code Detail

MEDICARE: RENASCENCE VITALITY-N-MOVEMENT LLC

MEDICARE: RENASCENCE VITALITY-N-MOVEMENT LLC
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
12251X0800XOrthopedic Physical Therapist

General Provider Information

NPI Number : 1619846839
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENASCENCE VITALITY-N-MOVEMENT LLC
Provider Business Mailing Address
First Line : 2059 SCENIC HWY N STE 130B
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-6142
Country : US
Telephone Number : 678-517-2064
Fax Number : 678-609-1421
Provider Business Practice Location Address
First Line : 2059 SCENIC HWY N STE 130B
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-6142
Country : US
Telephone Number : 678-517-2064
Fax Number : 678-609-1421
Authorized Official
Title or Position : OWNER/PHYSICAL THERAPIST
Name : ANGEL DAMETREA WILLIAMS
Credential : PT, DPT, OCS
Telephone Number : 678-517-2064
Provider Enumeration Date : 11/04/2025
Last Update Date : 11/04/2025

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Directions to “RENASCENCE VITALITY-N-MOVEMENT LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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