Provider Demographics
NPI:1063927978
Name:THE RESTORATION SPACE LLC
Entity type:Organization
Organization Name:THE RESTORATION SPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:EYVAZZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-594-2060
Mailing Address - Street 1:406 DELAWARE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:406 DELAWARE AVE STE 104
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1469
Practice Address - Country:US
Practice Address - Phone:610-594-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty