NPIMap

Organization Active NPI

Renew Physical Therapy PLLC

  • Physical Therapist
  • Bentonville, AR
National Provider Identifier
1699443119
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
RENEW PHYSICAL THERAPY PLLC
Practice address
1010 NW J St Ste I
Bentonville, AR 72712-4155
Phone
(859) 585-7338
NPI assigned
Aug 31, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Authorized official

Name
Chelsea Waldkirch, DPTNPI 1033584412
Title
Owner
Phone
(859) 585-7338

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

1010 NW J St Ste I
Bentonville, AR 72712-4155

Mailing address

131 Florence Dr
Centerton, AR 72719-9499
Phone (859) 585-7338

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220221000112 AR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9133526262 Receives reassigned benefits from 7 practitioners
Practice locations: Bentonville, AR; Rogers, AR

National Provider Directory

National Provider Directory

Locations

210 N Walton Blvd
Ste 26
Bentonville, AR 72712
Phone (479) 440-4147

1010 NW J St
Ste I
Bentonville, AR 72712
Phone (479) 440-4147

2522 S Pinnacle Hills Pkwy
Ste 200
Rogers, AR 72758
Phone (479) 440-4147

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1699443119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 FLORENCE DR",
            "city": "CENTERTON",
            "state": "AR",
            "postal_code": "727199499",
            "telephone_number": "859-585-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 NW J ST STE I",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124155",
            "telephone_number": "859-585-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "WALDKIRCH",
        "authorized_official_first_name": "CHELSEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-585-7338",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.