# RENEW SPINE AND REHAB INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861206153
- **Authorized official:** MORGAN GLAZER (COO)
- **Authorized official phone:** (248) 353-2225

## Contact information

- **Practice address:** 24725 W 12 MILE RD STE 260, SOUTHFIELD, MI 48034-8310
- **Practice address phone:** (248) 353-2225
- **Practice address fax:** (248) 353-2239
- **Mailing address:** 24725 W 12 MILE RD STE 260, SOUTHFIELD, MI 48034-8310
- **Mailing address phone:** (248) 353-2225
- **Mailing address fax:** (248) 353-2239

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | — | NULL | — |
| 111NR0400X | Rehabilitation Chiropractor | — | — | — |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | — | NULL | Yes |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | — | — | Yes |
| 2251S0007X | Sports Physical Therapist | — | NULL | — |
| 2251S0007X | Sports Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 02/05/2025
- **Last updated:** 02/05/2025