Provider Demographics
NPI:1669354817
Name:MUSCLE RESTORATION, INC.
Entity type:Organization
Organization Name:MUSCLE RESTORATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-449-9757
Mailing Address - Street 1:4532 MCMURRY AVE UNIT 204
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-8022
Mailing Address - Country:US
Mailing Address - Phone:402-363-1864
Mailing Address - Fax:
Practice Address - Street 1:4532 MCMURRY AVE UNIT 204
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-8022
Practice Address - Country:US
Practice Address - Phone:402-363-1864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty