Provider Demographics
NPI:1689861288
Name:RESTORATION BODY WORKS WELLNESS AND PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:RESTORATION BODY WORKS WELLNESS AND PHYSICAL THERAPY, PLLC
Other - Org Name:RESTORATION BODY WORKS WELLNESS AND PHYSICAL THERAPY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-213-9730
Mailing Address - Street 1:710 N BEAVER ST BLDG 6
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3148
Mailing Address - Country:US
Mailing Address - Phone:928-213-9730
Mailing Address - Fax:928-213-9732
Practice Address - Street 1:710 N BEAVER ST BLDG 6
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3148
Practice Address - Country:US
Practice Address - Phone:928-213-9730
Practice Address - Fax:928-213-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75738Medicare PIN