Healthcare Provider Details

I. General information

NPI: 1548967599
Provider Name (Legal Business Name): RESTORE PELVIC HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 CALLE CRISTOBAL UNIT 92
SAN DIEGO CA
92126-6074
US

IV. Provider business mailing address

7340 CALLE CRISTOBAL UNIT 92
SAN DIEGO CA
92126-6074
US

V. Phone/Fax

Practice location:
  • Phone: 301-938-3412
  • Fax:
Mailing address:
  • Phone: 301-938-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: REBECCA JACOBS
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 301-938-3412