Provider Demographics
NPI:1518226893
Name:RESTORATIVE PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:RESTORATIVE PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUITO
Authorized Official - Middle Name:
Authorized Official - Last Name:EBUNA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-442-7900
Mailing Address - Street 1:121 S OCEAN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4558
Mailing Address - Country:US
Mailing Address - Phone:516-442-7900
Mailing Address - Fax:516-442-7900
Practice Address - Street 1:121 S OCEAN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4558
Practice Address - Country:US
Practice Address - Phone:516-442-7900
Practice Address - Fax:516-442-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020516261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy