Provider Demographics
NPI:1285842799
Name:RESTORATION PHYSICAL THERAPY, LLC.
Entity Type:Organization
Organization Name:RESTORATION PHYSICAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:BARNER
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:770-222-6621
Mailing Address - Street 1:5077 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:SUITE 119
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141
Mailing Address - Country:US
Mailing Address - Phone:770-222-6621
Mailing Address - Fax:770-222-8845
Practice Address - Street 1:5077 JIMMY LEE SMITH PKWY
Practice Address - Street 2:SUITE 119
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:770-222-6621
Practice Address - Fax:770-222-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy