Organization
RENEW PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN N CERALDE (PRESIDENT)
(815) 517-1025
Entity
Organization
Contact information
Practice address
123 E LINCOLN HWY, DEKALB, IL 60115-3205
(815) 517-1025
(815) 901-0313
Mailing address
123 E LINCOLN HWY, DEKALB, IL 60115-3205
(815) 517-1025
(815) 901-0313
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
070011875
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00240612
RR MEDICARE
IL
Enumeration date
08/05/2014
Last updated
11/18/2014
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