Provider Demographics
NPI:1346953700
Name:RESTORATIVE MOBILE THERAPY
Entity Type:Organization
Organization Name:RESTORATIVE MOBILE THERAPY
Other - Org Name:VISIONARY PHYSICAL THERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:475-298-5388
Mailing Address - Street 1:64 COUNTRY PL
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3862
Mailing Address - Country:US
Mailing Address - Phone:475-298-5388
Mailing Address - Fax:
Practice Address - Street 1:85 MILL PLAIN RD STE P
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5001
Practice Address - Country:US
Practice Address - Phone:475-298-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy