Provider Demographics
NPI:1316403165
Name:RESTORE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:RESTORE PHYSICAL THERAPY, LLC
Other - Org Name:RESTORE PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ZARRIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:401-250-3060
Mailing Address - Street 1:10 WORTHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-7951
Mailing Address - Country:US
Mailing Address - Phone:401-338-1713
Mailing Address - Fax:401-244-7044
Practice Address - Street 1:10 WORTHINGTON RD STE J
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7951
Practice Address - Country:US
Practice Address - Phone:401-250-3060
Practice Address - Fax:401-244-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy