Provider Demographics
NPI:1740066331
Name:RESTORE THERAPY GROUP
Entity type:Organization
Organization Name:RESTORE THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAFFERNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-318-0506
Mailing Address - Street 1:2583 TURPINS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-5820
Mailing Address - Country:US
Mailing Address - Phone:901-318-0506
Mailing Address - Fax:
Practice Address - Street 1:2583 TURPINS GLEN DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-5820
Practice Address - Country:US
Practice Address - Phone:901-318-0506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty