Provider Demographics
NPI:1306184833
Name:RESTORE PLUS PHYSICAL THERAPY & REHABILITATION PLLC
Entity Type:Organization
Organization Name:RESTORE PLUS PHYSICAL THERAPY & REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TIU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:800-905-0513
Mailing Address - Street 1:3310 QUEENS BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2302
Mailing Address - Country:US
Mailing Address - Phone:800-905-0513
Mailing Address - Fax:347-536-3955
Practice Address - Street 1:3310 QUEENS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2302
Practice Address - Country:US
Practice Address - Phone:800-905-0513
Practice Address - Fax:347-536-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024790-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty