Basic Information
| Provider Information | |||||||||
| NPI: | 1720756158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESTORE PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1337 HARDY RD STE 10 | ||||||||
| Address2: | |||||||||
| City: | VINTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241792247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406478331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1337 HARDY RD STE 10 | ||||||||
| Address2: | |||||||||
| City: | VINTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241792247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406478331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2021 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | SADDHRA | ||||||||
| AuthorizedOfficialFirstName: | RORIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5404675789 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.