Provider Demographics
NPI:1083266191
Name:RESTORE THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:RESTORE THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:343-425-8063
Mailing Address - Street 1:4210 LOMAC ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2817
Mailing Address - Country:US
Mailing Address - Phone:334-425-8063
Mailing Address - Fax:
Practice Address - Street 1:4210 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2817
Practice Address - Country:US
Practice Address - Phone:334-425-8063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty