Provider Demographics
NPI:1831651678
Name:RESTORATION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RESTORATION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JURKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-860-3117
Mailing Address - Street 1:2637 E ATLANTIC BLVD # 1064
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4939
Mailing Address - Country:US
Mailing Address - Phone:954-860-3117
Mailing Address - Fax:
Practice Address - Street 1:4020 W PALM AIRE DR APT 201
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4159
Practice Address - Country:US
Practice Address - Phone:954-860-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty