Renew Physical Therapy Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

070011875 Issued in IL

Legal business name

RENEW PHYSICAL THERAPY INC

Practice address

123 E Lincoln Hwy
Dekalb, IL 60115-3205

Phone

(815) 517-1025

Fax

(815) 901-0313

NPI assigned

Aug 5, 2014

Organization subpart

No

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

Authorized official

Name

Kristin N Ceralde

Title

President

Phone

(815) 517-1025

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416268800000",
    "number": "1700295631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 E LINCOLN HWY",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601153205",
            "telephone_number": "815-517-1025",
            "fax_number": "815-901-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 E LINCOLN HWY",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601153205",
            "telephone_number": "815-517-1025",
            "fax_number": "815-901-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-05",
        "last_updated": "2014-11-18",
        "status": "A",
        "authorized_official_last_name": "CERALDE",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-517-1025"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070011875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00240612",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Lil Porter Reedman
• Amanda Marie Reeves
• Maris Emma Reid, SLP
• Valerie Lynn Renard
• Renew Orthodontics
• Resilient Life Counseling PLLC
• Michael D Reuland, DPT
• Rice Enterprises LLC
• Aiesha Kateria Rice-Dainty, MSW
• Ronald L Rice, D.C.

• Physical Therapy Clinic/Center in Dekalb, IL
• Providers in Dekalb, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; 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.