Healthcare Provider Details

I. General information

NPI: 1720756158
Provider Name (Legal Business Name): RESTORE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 E WASHINGTON AVE STE C
VINTON VA
24179-4601
US

IV. Provider business mailing address

2125 E WASHINGTON AVE STE C
VINTON VA
24179-4601
US

V. Phone/Fax

Practice location:
  • Phone: 540-647-8331
  • Fax: 540-491-9737
Mailing address:
  • Phone: 540-647-8331
  • Fax: 540-491-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: RORIE SADDHRA
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 540-467-5789