Healthcare Provider Details

I. General information

NPI: 1689328254
Provider Name (Legal Business Name): RESTORE THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 68TH ST S
FARGO ND
58104-5639
US

IV. Provider business mailing address

6124 68TH ST S
FARGO ND
58104-5639
US

V. Phone/Fax

Practice location:
  • Phone: 701-220-8773
  • Fax:
Mailing address:
  • Phone: 701-220-8773
  • 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

VIII. Authorized Official

Name: SCOTT BARNHARDT
Title or Position: OWNER
Credential: PT
Phone: 701-220-8773