Healthcare Provider Details

I. General information

NPI: 1528524832
Provider Name (Legal Business Name): RESTORE THERAPY SERVICES OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S KINGS AVE
BRANDON FL
33511-5925
US

IV. Provider business mailing address

245 CAHABA VALLEY PKWY STE 200
PELHAM AL
35124-2217
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 State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE KNOWLES CULPEPPER
Title or Position: OUTPATIENT PROGRAM DIRECTOR
Credential:
Phone: 205-941-6820