Provider Demographics
NPI:1508196502
Name:RESTORATION REHABILITATION INC
Entity Type:Organization
Organization Name:RESTORATION REHABILITATION INC
Other - Org Name:RESTORATION REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHEUFFELE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-549-5668
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-0306
Mailing Address - Country:US
Mailing Address - Phone:360-273-4747
Mailing Address - Fax:360-273-4747
Practice Address - Street 1:10119 HIGHWAY 12 SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-8621
Practice Address - Country:US
Practice Address - Phone:360-273-4747
Practice Address - Fax:360-273-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7145766Medicaid
WA2496SCOtherREGENCE BLUE SHIELD
WA236625OtherDEPARTMENT OF LABOR & INDUSTRIES