Provider Demographics
NPI:1548565963
Name:RESTORE MOTION
Entity Type:Organization
Organization Name:RESTORE MOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-881-9313
Mailing Address - Street 1:5410 EDSON LN
Mailing Address - Street 2:350
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3107
Mailing Address - Country:US
Mailing Address - Phone:301-881-9313
Mailing Address - Fax:301-881-9312
Practice Address - Street 1:5410 EDSON LN
Practice Address - Street 2:350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3107
Practice Address - Country:US
Practice Address - Phone:301-881-9313
Practice Address - Fax:301-881-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17909225100000X
MD18266225100000X
MD17216225100000X
MD18616225100000X
MD20792225100000X
MD15626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty