Provider Demographics
NPI:1093352924
Name:RESTORATION MIND BODY & SOLE
Entity Type:Organization
Organization Name:RESTORATION MIND BODY & SOLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:T
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MMT
Authorized Official - Phone:334-521-6080
Mailing Address - Street 1:1995 PEPPERELL PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5460
Mailing Address - Country:US
Mailing Address - Phone:334-521-6080
Mailing Address - Fax:
Practice Address - Street 1:1995 PEPPERELL PKWY STE 5
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5460
Practice Address - Country:US
Practice Address - Phone:334-521-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty