Healthcare Provider Details

I. General information

NPI: 1568378347
Provider Name (Legal Business Name): RESTORED PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAPLEWOOD AVE
CLEARWATER FL
33765-3332
US

IV. Provider business mailing address

100 MAPLEWOOD AVE
CLEARWATER FL
33765-3332
US

V. Phone/Fax

Practice location:
  • Phone: 516-578-6609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MARTIN DASZYKOWSKI
Title or Position: OWNER
Credential:
Phone: 516-578-6609