Provider Demographics
NPI:1619576907
Name:RESTORATIVE MANUAL PHYSICAL THERAPY & FITNESS LLC
Entity Type:Organization
Organization Name:RESTORATIVE MANUAL PHYSICAL THERAPY & FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:216-233-4298
Mailing Address - Street 1:3521 WILSHIRE WAY APT 4123
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-0080
Mailing Address - Country:US
Mailing Address - Phone:216-233-4298
Mailing Address - Fax:
Practice Address - Street 1:601 W PLANO PKWY STE 141A
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8969
Practice Address - Country:US
Practice Address - Phone:972-398-0789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty