Basic Information
| Provider Information | |||||||||
| NPI: | 1528524832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESTORE THERAPY SERVICES OF FLORIDA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 CAHABA VALLEY PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351242217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059426820 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 S KINGS AVE | ||||||||
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| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059426820 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2019 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | CULPEPPER | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | KNOWLES | ||||||||
| AuthorizedOfficialTitleorPosition: | OUTPATIENT PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2059416820 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RESTORE THERAPY SERVICES OF FLORIDA LLC | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.