Provider Demographics
NPI:1619846839
Name:RENASCENCE VITALITY-N-MOVEMENT LLC
Entity type:Organization
Organization Name:RENASCENCE VITALITY-N-MOVEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:DAMETREA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:678-517-2064
Mailing Address - Street 1:2059 SCENIC HWY N STE 130B
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6142
Mailing Address - Country:US
Mailing Address - Phone:678-517-2064
Mailing Address - Fax:678-609-1421
Practice Address - Street 1:2059 SCENIC HWY N STE 130B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6142
Practice Address - Country:US
Practice Address - Phone:678-517-2064
Practice Address - Fax:678-609-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty