Renew Therapy Center of Palm Bay, LLC

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

RENEW THERAPY CENTER OF PALM BAY, LLC

Practice address

490 Centre Lake Dr NE
Suite 100
Palm Bay, FL 32907-1189

Phone

(321) 768-9776

Fax

(321) 768-9739

NPI assigned

Mar 9, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Alfonso Ocasio

Title

Clinic Administrator

Phone

(321) 768-9776

Specialties & licenses 1

Addresses

Other names 1

• Renew Therapy Centers Other name

Locations

Practitioners 1

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.

• Nomara Jeanne Buck, PTA

  • Physical Therapy Assistant
  • Palm Bay, FL
  • NPI 1073639456
  NPD (past)

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316915184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 CENTRE LAKE DR NE",
            "address_2": "SUITE 100",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329071189",
            "telephone_number": "321-768-9776",
            "fax_number": "321-768-9739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 CENTRE LAKE DR NE",
            "address_2": "SUITE 100",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329071189",
            "telephone_number": "321-768-9776",
            "fax_number": "321-768-9739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW THERAPY CENTER OF PALM BAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OCASIO",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "321-768-9776",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renew Therapy Centers",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Comprehensive Outpatient Rehabilitation Facility (CORF) in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.