Provider Demographics
NPI:1740478536
Name:RESTORATION PHYSICAL THERAPY
Entity type:Organization
Organization Name:RESTORATION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BEARDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-703-9593
Mailing Address - Street 1:5348 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1739
Mailing Address - Country:US
Mailing Address - Phone:818-703-9593
Mailing Address - Fax:818-703-9595
Practice Address - Street 1:5348 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1739
Practice Address - Country:US
Practice Address - Phone:818-703-9593
Practice Address - Fax:818-703-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
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
CAW19767Medicare PIN