Provider Demographics
NPI:1093059354
Name:RESTORE PHYSICAL THERAPY AND WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:RESTORE PHYSICAL THERAPY AND WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JULIE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:413-387-0722
Mailing Address - Street 1:220 RUSSELL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9542
Mailing Address - Country:US
Mailing Address - Phone:413-387-0722
Mailing Address - Fax:413-387-0723
Practice Address - Street 1:220 RUSSELL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9542
Practice Address - Country:US
Practice Address - Phone:413-387-0722
Practice Address - Fax:413-387-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17287261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy