Provider Demographics
NPI:1649599168
Name:RESTORATIVE HEALTH REHABILITATION INC
Entity Type:Organization
Organization Name:RESTORATIVE HEALTH REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:FISKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-801-1616
Mailing Address - Street 1:18701 SW 291ST TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3014
Mailing Address - Country:US
Mailing Address - Phone:305-801-1616
Mailing Address - Fax:
Practice Address - Street 1:2804 NE 8TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5613
Practice Address - Country:US
Practice Address - Phone:305-801-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FLPT 15371261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy