Provider Demographics
NPI:1093316408
Name:RESTORE PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:RESTORE PHYSICAL THERAPY & WELLNESS
Other - Org Name:JOHN SANTOSUOSSO, JR.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOSUOSSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MPT, LMT
Authorized Official - Phone:609-553-8000
Mailing Address - Street 1:507 E REVERE WAY
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3225
Mailing Address - Country:US
Mailing Address - Phone:609-553-8000
Mailing Address - Fax:
Practice Address - Street 1:507 E REVERE WAY
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-3225
Practice Address - Country:US
Practice Address - Phone:609-553-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy