Healthcare Provider Details

I. General information

NPI: 1588193114
Provider Name (Legal Business Name): RESTORE THERAPY SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 DATA DR
HOOVER AL
35244-2521
US

IV. Provider business mailing address

245 CAHABA VALLEY PKWY
PELHAM AL
35124-2216
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEBBIE KNOWLES
Title or Position: DIRECTOR OF OUTPATIENT
Credential:
Phone: 205-942-6820