Provider Demographics
NPI:1194195461
Name:RESTORE PHYSICAL THERAPY PS
Entity Type:Organization
Organization Name:RESTORE PHYSICAL THERAPY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, JSCC
Authorized Official - Phone:253-446-6507
Mailing Address - Street 1:13909 MERIDIAN E STE A2
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-9180
Mailing Address - Country:US
Mailing Address - Phone:253-446-6507
Mailing Address - Fax:253-446-6194
Practice Address - Street 1:13909 MERIDIAN E STE A2
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-9180
Practice Address - Country:US
Practice Address - Phone:253-446-6507
Practice Address - Fax:253-446-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT6891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty