Provider Demographics
NPI:1225899834
Name:RESTORE PHYSICAL THERAPY PILATES & FITNESS PLLC
Entity Type:Organization
Organization Name:RESTORE PHYSICAL THERAPY PILATES & FITNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:571-556-8062
Mailing Address - Street 1:14070 BETSY ROSS LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3511
Mailing Address - Country:US
Mailing Address - Phone:571-556-8062
Mailing Address - Fax:571-292-8510
Practice Address - Street 1:14070 BETSY ROSS LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-3511
Practice Address - Country:US
Practice Address - Phone:571-556-8062
Practice Address - Fax:571-292-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy