Provider Demographics
NPI:1699443119
Name:RENEW PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:RENEW PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDKIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:859-585-7338
Mailing Address - Street 1:131 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9499
Mailing Address - Country:US
Mailing Address - Phone:859-585-7338
Mailing Address - Fax:
Practice Address - Street 1:1010 NW J ST STE I
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4155
Practice Address - Country:US
Practice Address - Phone:859-585-7338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty