Renova Pt Llc is a medicare enrolled "Physical Therapist" provider in Afton, Tennessee. Their current practice location is
525 Calico Rd, Afton, Tennessee. You can reach out to their office (for appointments etc.) via phone at
(423) 788-5106.
Renova Pt Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Renova Pt Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1164291688.
Healthcare Provider's Profile
| Full Name | Renova Pt Llc |
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| Type | Facility |
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| Speciality | Physical Therapist |
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| Location | 525 Calico Rd, Afton, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1164291688
- Provider Enumeration Date: 12/26/2023
- Last Update Date: 12/26/2023
Medicare PECOS Information:
- PECOS PAC ID: 3476996299
- Enrollment ID: O20240208003331
Medical Identifiers
Medical identifiers for Renova Pt Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1164291688 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Renova Pt Llc acts as a billing entity for following providers:
| Provider Name | Milton De Brun |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1720351034
PECOS PAC ID: 7113323122
Enrollment ID: I20240208003743 |
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| Provider Name | Lissie Mayer |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1417220740
PECOS PAC ID: 6800231788
Enrollment ID: I20240301000944 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Renova Pt Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Renova Pt Llc
1113 Tusculum Blvd # 104,
Greeneville, TN 37745-4038
Ph: () - | Renova Pt Llc
525 Calico Rd,
Afton, TN 37616-6631
Ph: (423) 788-5106 |
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