Provider Demographics
NPI:1366436313
Name:RESTORATIVE WOMEN'S WELLNESS, LLC
Entity type:Organization
Organization Name:RESTORATIVE WOMEN'S WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:BERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, NTP, LMT
Authorized Official - Phone:208-866-6549
Mailing Address - Street 1:2525 N STOKESBERRY PL UNIT A
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1510
Mailing Address - Country:US
Mailing Address - Phone:208-378-1517
Mailing Address - Fax:208-939-8597
Practice Address - Street 1:2525 N STOKESBERRY PL UNIT A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1510
Practice Address - Country:US
Practice Address - Phone:208-378-1517
Practice Address - Fax:208-939-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-2552255A2300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty