Healthcare Provider Details

I. General information

NPI: 1285060863
Provider Name (Legal Business Name): RESTORATIVE THERAPY OUTPATIENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 MARINER BLVD
SPRING HILL FL
34609-2469
US

IV. Provider business mailing address

4121 MARINER BLVD
SPRING HILL FL
34609-2469
US

V. Phone/Fax

Practice location:
  • Phone: 352-340-5924
  • Fax: 352-340-5926
Mailing address:
  • Phone: 352-340-5924
  • Fax: 352-340-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUSTIN SPIEGEL
Title or Position: ADMINISTRATOR & V.P.
Credential: P.T.
Phone: 352-340-5924