Provider Demographics
NPI:1558972786
Name:RESTORE AND CORE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:RESTORE AND CORE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIEMBOB
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:413-348-8247
Mailing Address - Street 1:6360 S 3000 E STE 210
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6972
Mailing Address - Country:US
Mailing Address - Phone:435-615-8822
Mailing Address - Fax:435-615-8823
Practice Address - Street 1:6360 S 3000 E STE 210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6972
Practice Address - Country:US
Practice Address - Phone:435-615-8822
Practice Address - Fax:435-615-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty