Healthcare Provider Details

I. General information

NPI: 1942948427
Provider Name (Legal Business Name): RESTORE PELVIC HEALTH PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 WESTGATE PKWY STE 7
DOTHAN AL
36303-2154
US

IV. Provider business mailing address

1314 WESTGATE PKWY STE 7
DOTHAN AL
36303-2154
US

V. Phone/Fax

Practice location:
  • Phone: 205-492-3216
  • Fax: 334-268-5865
Mailing address:
  • Phone: 334-268-5880
  • Fax: 334-268-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLI DANIELS
Title or Position: OWNER
Credential: PT, DPT
Phone: 334-701-4800