Healthcare Provider Details

I. General information

NPI: 1023056140
Provider Name (Legal Business Name): RESTOR PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PEAR AVE SUITE 101
MOUNTAIN VIEW CA
94043-1444
US

IV. Provider business mailing address

PO BOX 8125
FOUNTAIN VALLEY CA
92728-8125
US

V. Phone/Fax

Practice location:
  • Phone: 714-638-8693
  • Fax: 714-638-3940
Mailing address:
  • Phone: 714-638-8693
  • Fax: 714-638-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN R HORSLEY
Title or Position: PRESIDENT
Credential: P.T.
Phone: 714-638-8693