Provider Demographics
NPI:1871244319
Name:RESTORED MOVEMENT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:RESTORED MOVEMENT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:II
Authorized Official - Credentials:DPT
Authorized Official - Phone:704-293-0202
Mailing Address - Street 1:3215 WINDSHIRE LN UNIT 210
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4190
Mailing Address - Country:US
Mailing Address - Phone:704-293-0202
Mailing Address - Fax:
Practice Address - Street 1:3215 WINDSHIRE LN UNIT 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4190
Practice Address - Country:US
Practice Address - Phone:704-293-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy