Healthcare Provider Details

I. General information

NPI: 1619883584
Provider Name (Legal Business Name): RESTORE PHYSICAL THERAPY CLINIC L.L.C
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

24515 KINGS POINTE
NOVI MI
48375-2715
US

IV. Provider business mailing address

24515 KINGS POINTE
NOVI MI
48375-2715
US

V. Phone/Fax

Practice location:
  • Phone: 248-943-1169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NIRAV KUMAR UPADHYAY
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 248-943-1169