Provider Demographics
NPI:1609391853
Name:RESTORATION HEALTH OF SOUTH ALABAMA, INC
Entity Type:Organization
Organization Name:RESTORATION HEALTH OF SOUTH ALABAMA, INC
Other - Org Name:RESTORATION HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:RAINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-626-0732
Mailing Address - Street 1:3280 DAUPHIN ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4060
Mailing Address - Country:US
Mailing Address - Phone:251-450-3700
Mailing Address - Fax:251-545-3010
Practice Address - Street 1:30762 STATE HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5672
Practice Address - Country:US
Practice Address - Phone:251-626-0732
Practice Address - Fax:251-272-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty