Provider Demographics
NPI:1215374384
Name:RESTORATIVE PROSTHETICS & ORTHOTICS LLC
Entity Type:Organization
Organization Name:RESTORATIVE PROSTHETICS & ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.P.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:RESTIVO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:251-654-6012
Mailing Address - Street 1:3456 SPRING HILL AVE
Mailing Address - Street 2:STE19
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3456 SPRING HILL AVE
Practice Address - Street 2:STE19
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1523
Practice Address - Country:US
Practice Address - Phone:251-654-6012
Practice Address - Fax:251-345-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier