Provider Demographics
NPI:1316505563
Name:RESTORE THE MACHINE - PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:RESTORE THE MACHINE - PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOYANAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:310-373-5288
Mailing Address - Street 1:23332 HAWTHORNE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3767
Mailing Address - Country:US
Mailing Address - Phone:310-373-5288
Mailing Address - Fax:
Practice Address - Street 1:23332 HAWTHORNE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3767
Practice Address - Country:US
Practice Address - Phone:310-373-5288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty