Provider Demographics
NPI:1578799219
Name:RESTORE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RESTORE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-692-6640
Mailing Address - Street 1:94 MOUNTAIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-5500
Mailing Address - Country:US
Mailing Address - Phone:828-692-6640
Mailing Address - Fax:828-689-3089
Practice Address - Street 1:105 CHESTNUT ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-9602
Practice Address - Country:US
Practice Address - Phone:828-692-6640
Practice Address - Fax:828-689-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2505903BMedicare PIN