Provider Demographics
NPI:1548011810
Name:RENEWFRP, PHYSICAL THERAPY,PC
Entity type:Organization
Organization Name:RENEWFRP, PHYSICAL THERAPY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-754-7268
Mailing Address - Street 1:PO BOX 8125
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8125
Mailing Address - Country:US
Mailing Address - Phone:714-754-7268
Mailing Address - Fax:714-434-7042
Practice Address - Street 1:441 OLD NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4210
Practice Address - Country:US
Practice Address - Phone:949-525-9995
Practice Address - Fax:714-434-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service