Provider Demographics
NPI:1528725900
Name:RESTORE NEUROREHAB PLLC
Entity type:Organization
Organization Name:RESTORE NEUROREHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FASICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, NCS
Authorized Official - Phone:847-345-3375
Mailing Address - Street 1:306 S WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2939
Mailing Address - Country:US
Mailing Address - Phone:847-345-3375
Mailing Address - Fax:
Practice Address - Street 1:1529 S GROVE AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5211
Practice Address - Country:US
Practice Address - Phone:847-800-6162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation