MEDICARE: RESTORE PHYSICAL THERAPY AND WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1972345973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE PHYSICAL THERAPY AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	5824 FRYAR LN
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-7323
Country	:	US
Telephone Number	:	517-614-5671
Fax Number	:

Provider Business Practice Location Address
First Line	:	5824 FRYAR LN
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-7323
Country	:	US
Telephone Number	:	517-614-5671
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	SHILPA KUNDESHWAR
Credential	:	PT
Telephone Number	:	517-614-5671

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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