Provider Demographics
NPI:1699012971
Name:BODY RESTORATION PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:BODY RESTORATION PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-399-2503
Mailing Address - Street 1:200 S SERVICE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2118
Mailing Address - Country:US
Mailing Address - Phone:516-399-2503
Mailing Address - Fax:516-908-3999
Practice Address - Street 1:200 S SERVICE RD STE 209
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2118
Practice Address - Country:US
Practice Address - Phone:516-399-2503
Practice Address - Fax:516-908-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029070261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy