Provider Demographics
NPI:1285083428
Name:RESTORE HEALTH AND WELLNESS PLLC
Entity type:Organization
Organization Name:RESTORE HEALTH AND WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-517-2162
Mailing Address - Street 1:360 EL GRECO DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9633
Mailing Address - Country:US
Mailing Address - Phone:615-517-2162
Mailing Address - Fax:855-422-2581
Practice Address - Street 1:360 EL GRECO DR
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9633
Practice Address - Country:US
Practice Address - Phone:615-517-2162
Practice Address - Fax:855-422-2581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119800207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME119800OtherLICENSE
FLIA7132Medicare UPIN