Provider Demographics
NPI:1972925337
Name:RESTORE & RENEW MEDICAL MASSAGE
Entity type:Organization
Organization Name:RESTORE & RENEW MEDICAL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, PTA
Authorized Official - Phone:304-647-3233
Mailing Address - Street 1:318 W. WASHINGTON ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1316
Mailing Address - Country:US
Mailing Address - Phone:304-647-3233
Mailing Address - Fax:
Practice Address - Street 1:318 W. WASHINGTON ST.
Practice Address - Street 2:SUITE B
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1316
Practice Address - Country:US
Practice Address - Phone:304-647-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2001-1648225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty