Provider Demographics
NPI:1871165019
Name:RENEWED STRENGTH THERAPY CENTER, LLC
Entity type:Organization
Organization Name:RENEWED STRENGTH THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT/REHABILITATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L, CFPS
Authorized Official - Phone:847-644-1280
Mailing Address - Street 1:3302 WEST LAKE ROAD
Mailing Address - Street 2:APARTMENT #126
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4339
Mailing Address - Country:US
Mailing Address - Phone:847-644-1280
Mailing Address - Fax:847-440-9000
Practice Address - Street 1:3302 WEST LAKE ROAD
Practice Address - Street 2:APARTMENT #126
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3677
Practice Address - Country:US
Practice Address - Phone:847-644-1280
Practice Address - Fax:847-440-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility