NPIMap

Organization Active NPI

Renew Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Novato, CA
National Provider Identifier
1255508453
Registry record updated Feb 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
23976 Issued in CA
Legal business name
RENEW PHYSICAL THERAPY PC
Practice address
1427 Grant Ave
Novato, CA 94945
Phone
(415) 895-1705
Fax
(415) 707-6776
NPI assigned
May 15, 2008
Last updated
Feb 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Stephen Mongiello I, PTNPI 1427154475
Title
Physical Therapist/Owner
Phone
(415) 381-8707

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 23976 CA Primary

Addresses

Primary practice location

1427 Grant Ave
Novato, CA 94945

Mailing address

1427 Grant Ave
Novato, CA 94945-3118
Phone (415) 895-6995

Other practice location 1

659 Commercial St Ste 101
San Francisco, CA 94111-2566

Other practice location 2

460 Boulevard Way Ste 2D
Piedmont, CA 94610-1525
Phone (510) 922-8872

Other practice location 3

9909 Mira Mesa Blvd Ste 260
San Diego, CA 92131-1064
Phone (858) 385-9400

Other practice location 4

1427 Grant Ave
Novato, CA 94945
Phone (415) 895-1705

Other practice location 5

591 Redwood Hwy Frontage Rd Ste 2235
Mill Valley, CA 94941-6028
Phone (415) 381-8707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120103000350 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6406022078 Receives reassigned benefits from 23 practitioners
Practice locations: Mill Valley, CA; Novato, CA; Piedmont, CA; San Diego, CA; San Francisco, CA

National Provider Directory

National Provider Directory

Locations

247 Shoreline Hwy
Ste A9
Mill Valley, CA 94941
Phone (415) 381-8707

591 Redwood Hwy Frontage Rd
Ste 2235
Mill Valley, CA 94941
Phone (415) 381-8707

1427 Grant Ave
Novato, CA 94945
Phone (415) 275-2377

460 Boulevard Way
Ste 2D
Piedmont, CA 94610
Phone (510) 922-8872

659 Commercial St
Ste 101
San Francisco, CA 94111
Phone (415) 904-8707

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581120000000",
    "number": "1255508453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1427 GRANT AVE",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949453118",
            "telephone_number": "415-895-6995",
            "fax_number": "415-707-6776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1427 GRANT AVE",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "94945",
            "telephone_number": "415-895-1705",
            "fax_number": "415-707-6776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "659 Commercial St Ste 101",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941112566",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "460 Boulevard Way Ste 2D",
            "address_purpose": "LOCATION",
            "city": "Piedmont",
            "state": "CA",
            "postal_code": "946101525",
            "country_code": "US",
            "telephone_number": "510-922-8872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9909 Mira Mesa Blvd Ste 260",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921311064",
            "country_code": "US",
            "telephone_number": "858-385-9400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1427 Grant Ave",
            "address_purpose": "LOCATION",
            "city": "Novato",
            "state": "CA",
            "postal_code": "94945",
            "country_code": "US",
            "telephone_number": "415-895-1705",
            "fax_number": "415-707-6776",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "591 Redwood Hwy Frontage Rd Ste 2235",
            "address_purpose": "LOCATION",
            "city": "Mill Valley",
            "state": "CA",
            "postal_code": "949416028",
            "country_code": "US",
            "telephone_number": "415-381-8707",
            "fax_number": "415-634-6033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RENEW PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-15",
        "last_updated": "2020-02-08",
        "certification_date": "2020-02-08",
        "status": "A",
        "authorized_official_last_name": "MONGIELLO",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "415-381-8707",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "23976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.