Provider Demographics
NPI:1992479646
Name:RESTORE PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:RESTORE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-369-6454
Mailing Address - Street 1:13726 E MONUMENT DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-7045
Mailing Address - Country:US
Mailing Address - Phone:518-369-6454
Mailing Address - Fax:
Practice Address - Street 1:13726 E MONUMENT DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-7045
Practice Address - Country:US
Practice Address - Phone:518-369-6454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty