Healthcare Provider Details

I. General information

NPI: 1568933455
Provider Name (Legal Business Name): RESTORE THERAPY SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 PARK PLZ
CLANTON AL
35045-2844
US

IV. Provider business mailing address

245 CAHABA VALLEY PKWY STE 200
PELHAM AL
35124-2217
US

V. Phone/Fax

Practice location:
  • Phone: 205-314-7227
  • Fax:
Mailing address:
  • Phone: 205-942-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA DAVISON
Title or Position: BILLING DIRECTOR
Credential:
Phone: 205-942-6820