Provider Demographics
NPI:1285840702
Name:RESTAURO, EMMYLOU BEROU (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:EMMYLOU
Middle Name:BEROU
Last Name:RESTAURO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2498 AUDRI LN
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-7071
Mailing Address - Country:US
Mailing Address - Phone:765-461-7084
Mailing Address - Fax:
Practice Address - Street 1:1800 N WABASH RD STE 300
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1300
Practice Address - Country:US
Practice Address - Phone:765-651-3229
Practice Address - Fax:765-651-3227
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007660A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist