Provider Demographics
NPI:1811583974
Name:RESTORE PHYSIOTHERAPY
Entity Type:Organization
Organization Name:RESTORE PHYSIOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAURIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:910-206-5596
Mailing Address - Street 1:6318 SEVEN LAKES WEST
Mailing Address - Street 2:111 CLAY CIRCLE
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376
Mailing Address - Country:US
Mailing Address - Phone:910-206-5596
Mailing Address - Fax:
Practice Address - Street 1:45 DOWD CIR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7901
Practice Address - Country:US
Practice Address - Phone:910-621-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy