Healthcare Provider Details

I. General information

NPI: 1093694598
Provider Name (Legal Business Name): RESTORA PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 NE BROADWAY ST
MYRTLE CREEK OR
97457-9039
US

IV. Provider business mailing address

PO BOX 6
MYRTLE CREEK OR
97457-0001
US

V. Phone/Fax

Practice location:
  • Phone: 541-860-8556
  • Fax:
Mailing address:
  • Phone: 541-860-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. JANET WALDEN
Title or Position: PRESIDENT & CEO
Credential: PT
Phone: 541-860-8556