Provider Demographics
NPI:1851912885
Name:RESTORED THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:RESTORED THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERRETT MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-452-4261
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-0311
Mailing Address - Country:US
Mailing Address - Phone:301-452-4261
Mailing Address - Fax:
Practice Address - Street 1:9372 CANTER DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9461
Practice Address - Country:US
Practice Address - Phone:301-452-4261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health