Provider Demographics
NPI:1932494424
Name:RESTORE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:RESTORE THERAPY SERVICES LLC
Other - Org Name:NEXT LEVEL THERAPY SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:HUMAN RESORCES
Authorized Official - Prefix:
Authorized Official - First Name:BREKELL
Authorized Official - Middle Name:
Authorized Official - Last Name:VALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-427-0196
Mailing Address - Street 1:6100 MILLER AVENUE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403
Mailing Address - Country:US
Mailing Address - Phone:219-427-0196
Mailing Address - Fax:219-427-0197
Practice Address - Street 1:6100 MILLER AVENUE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403
Practice Address - Country:US
Practice Address - Phone:219-427-0196
Practice Address - Fax:219-427-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002122A225100000X
IN22003661A225500000X
IN31001112A225X00000X
IN31004535A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty