Healthcare Provider Details

I. General information

NPI: 1952215519
Provider Name (Legal Business Name): RESTORED LIFE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E RAHN RD STE 101A
DAYTON OH
45429-5459
US

IV. Provider business mailing address

42 E RAHN RD STE 101A
DAYTON OH
45429-5459
US

V. Phone/Fax

Practice location:
  • Phone: 937-230-8534
  • Fax: 326-529-4053
Mailing address:
  • Phone: 937-230-8534
  • Fax: 326-529-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAILYNN VANHOESEN
Title or Position: OWNER
Credential: MSW, LISW-S
Phone: 937-902-3944