Provider Demographics
NPI:1851288971
Name:RESTORE PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:RESTORE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:THIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:337-446-7918
Mailing Address - Street 1:2835 VEROT SCHOOL RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6411
Mailing Address - Country:US
Mailing Address - Phone:337-446-7918
Mailing Address - Fax:337-201-9031
Practice Address - Street 1:2835 VEROT SCHOOL RD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6411
Practice Address - Country:US
Practice Address - Phone:337-446-7918
Practice Address - Fax:337-201-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy