Provider Demographics
NPI:1811358641
Name:NATIONAL INSTITUTE OF RESTORATIVE EXERCISE
Entity type:Organization
Organization Name:NATIONAL INSTITUTE OF RESTORATIVE EXERCISE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-892-4376
Mailing Address - Street 1:23504 LEYTE DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4524
Mailing Address - Country:US
Mailing Address - Phone:310-892-4376
Mailing Address - Fax:
Practice Address - Street 1:23504 LEYTE DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4524
Practice Address - Country:US
Practice Address - Phone:310-892-4376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty