RENEW PHYSICAL THERAPY, INC (NPI# 1639410434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639410434 |
| Entity Type | Organization |
| Organization Name | RENEW PHYSICAL THERAPY, INC |
| Practice Address |
2701 Larsen Rd Suite 111 Green Bay WI 54303-4863 |
| Practice Telephone | 9208832284 |
| Mailing Telephone | 9208832284 |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2013-03-22 |
| Authorized Official Name | DR. SHAWN E JACKSON (PHYSICAL THERAPIST) |
| Authorized Official Telephone | 9208332284 |
| Authorized Official Credential | DPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| Street Address |
2701 LARSEN RD SUITE 111 |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-4863 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942399449 | Risa Lynn Janowski | Counselor | 2701 Larsen Rd, Green Bay, WI 54303-4863 | 2006-10-12 |
| 1265863336 | Amber Gravitter | Counselor | 2701 Larsen Rd, Green Bay, WI 54303-4863 | 2013-11-27 |
| 1417242256 | Promises Counseling Services, LLC | Community/Behavioral Health | 2701 Larsen Rd, Green Bay, WI 54303-4863 | 2011-06-09 |
| 1053577825 | Shawn E Jackson | Physical Therapist | 2701 Larsen Rd, Suite 111, Green Bay, WI 54303-4863 | 2008-07-31 |
| 1285800052 | Brown County Oral Health Partnership, Inc. | Public Health or Welfare | 2701 Larsen Rd, Green Bay, WI 54303-4863 | 2008-05-01 |
| 1720132806 | Harbor Community Psychological Associates Sc | Psychologist | 2701 Larsen Rd, Green Bay, WI 54303-4863 | 2007-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619305703 | St. Mary's Hospital | Clinic/Center | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2013-10-29 |
| 1700068590 | Andresource, LLC | Clinic/Center | 1050 Circle Dr, Suite B, Green Bay, WI 54304-5568 | 2007-12-04 |
| 1992808166 | Bellin Health Physical Therapy Obgyn | Clinic/Center | 1537 Park Pl Ste 200, Green Bay, WI 54304-1974 | 2006-09-06 |
| 1194742692 | St Vincent Hospital-hospital Sisters-third Order of St Francis | Clinic/Center | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093313074 | Byond Physical Therapy, LLC | Clinic/Center | 11320 W Forest Home Ave, Franklin, WI 53132-1401 | 2020-10-13 |
| 1568078780 | Streamline Physical Therapy | Clinic/Center | 5806 Crabapple Ln, Madison, WI 53711-3437 | 2020-09-22 |
| 1790311199 | Exos Wi LLC | Clinic/Center | 7044 S Ballpark Dr Ste 300, Franklin, WI 53132-6910 | 2020-03-17 |
| 1831735885 | Garvey Physical Therapy & Wellness LLC | Clinic/Center | 417 Maple Ct, Campbellsport, WI 53010-3531 | 2019-11-25 |
| 1821649088 | Impact Physical Therapy & Performance LLC | Clinic/Center | 1155 Clarity Dr, Verona, WI 53593-9318 | 2019-09-27 |
| 1427605146 | Peak Endurance | Clinic/Center | 15 N Butler St, Madison, WI 53703-4237 | 2019-08-19 |
| 1558917617 | Quad/med, LLC | Clinic/Center | N61 W23044 Harry's Way, Sussex, WI 53089 | 2019-08-14 |
| 1619521267 | Space To Be Well, LLC | Clinic/Center | 1091 Sutherland Ave, River Falls, WI 54022-7509 | 2019-07-31 |
| 1346894656 | Cornerstone Physical Therapy, LLC | Clinic/Center | 2829 County Highway I Ste 3, Chippewa Falls, WI 54729-2678 | 2019-07-25 |
| 1619437514 | Resilience Rx LLC | Clinic/Center | 4708 Graywood Ct Apt 3, Nashotah, WI 53058-9688 | 2019-03-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.