Provider Demographics
NPI:1861206153
Name:RENEW SPINE AND REHAB INC
Entity type:Organization
Organization Name:RENEW SPINE AND REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-353-2225
Mailing Address - Street 1:24725 W 12 MILE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8310
Mailing Address - Country:US
Mailing Address - Phone:248-353-2225
Mailing Address - Fax:248-353-2239
Practice Address - Street 1:24725 W 12 MILE RD STE 260
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8310
Practice Address - Country:US
Practice Address - Phone:248-353-2225
Practice Address - Fax:248-353-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty