Provider Demographics
NPI:1518630078
Name:RESTORE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RESTORE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWUKU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:203-594-7771
Mailing Address - Street 1:30 VITTI ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4823
Mailing Address - Country:US
Mailing Address - Phone:203-594-7771
Mailing Address - Fax:203-594-7772
Practice Address - Street 1:30 VITTI ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4823
Practice Address - Country:US
Practice Address - Phone:203-594-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty