Provider Demographics
NPI:1962505149
Name:RESTORE THERAPIES, LLC
Entity Type:Organization
Organization Name:RESTORE THERAPIES, LLC
Other - Org Name:RESTORE PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-874-2500
Mailing Address - Street 1:2700 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6386
Mailing Address - Country:US
Mailing Address - Phone:813-874-2500
Mailing Address - Fax:
Practice Address - Street 1:2700 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6386
Practice Address - Country:US
Practice Address - Phone:813-874-2500
Practice Address - Fax:813-874-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY916WOtherBLUECROSS BLUESHIELDS FL
FLY916WOtherBLUECROSS BLUESHIELDS FL
FL=========OtherTRICARE
FLY916WOtherBLUECROSS BLUESHIELDS FL
FL=========OtherTRICARE