Provider Demographics
NPI:1699388017
Name:RESTORE TELETHERAPY, LLC
Entity Type:Organization
Organization Name:RESTORE TELETHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:BRIANA
Authorized Official - Last Name:ALLING
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:208-471-4069
Mailing Address - Street 1:PO BOX 3567
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-3567
Mailing Address - Country:US
Mailing Address - Phone:208-471-4069
Mailing Address - Fax:
Practice Address - Street 1:8546 N CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8259
Practice Address - Country:US
Practice Address - Phone:208-471-4069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty