Organization
RENEW PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN MONGIELLO I PT (PHYSICAL THERAPIST/OWNER)
(415) 381-8707
Entity
Organization
Contact information
Practice address
1427 GRANT AVE, NOVATO, CA 94945
(415) 895-1705
(415) 707-6776
Mailing address
1427 GRANT AVE, NOVATO, CA 94945-3118
(415) 895-6995
(415) 707-6776
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
23976
CA
Other
Enumeration date
05/15/2008
Last updated
02/08/2020
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