Provider Demographics
NPI:1417653577
Name:PT AND RESTORATIVE WELLNESS
Entity Type:Organization
Organization Name:PT AND RESTORATIVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:310-734-7181
Mailing Address - Street 1:8635 W 3RD ST STE 1180
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6114
Mailing Address - Country:US
Mailing Address - Phone:310-734-7181
Mailing Address - Fax:310-460-0099
Practice Address - Street 1:8635 W 3RD ST STE 1180
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6114
Practice Address - Country:US
Practice Address - Phone:310-734-7181
Practice Address - Fax:310-460-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306425822OtherPERSONAL NPI