MEDICARE: RENAISSANCE PHYSICAL THERAPY ARTS AND WELLNESS

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
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1639475627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE PHYSICAL THERAPY ARTS AND WELLNESS

Provider Business Mailing Address
First Line	:	734 VALLEY RD STE 102
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1522
Country	:	US
Telephone Number	:	973-707-7944
Fax Number	:	973-707-7541

Provider Business Practice Location Address
First Line	:	734 VALLEY RD STE 102
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1522
Country	:	US
Telephone Number	:	973-707-7944
Fax Number	:	973-707-7541

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CARYN BINDER-BREGMAN
Credential	:	P.T.
Telephone Number	:	973-707-7944

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	11/14/2016

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Directions to “RENAISSANCE PHYSICAL THERAPY ARTS AND WELLNESS ” Practice Location

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