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General NPI Number Information
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NPI Number | 1043879174
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Entity Type | Organization
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Legal Business Name | RESTORATION BODYWORKS, PLLC
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 2116 HEATHER HILL LN
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City | PLANO
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State | TX
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Zip | 75075-2942
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Country | US
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Telephone | 512-903-5442
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262294
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City | PLANO
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State | TX
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Zip | 75026-2294
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Country | US
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Telephone | 512-903-5442
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LARA LANIER PITT
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Credential | PT
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Telephone | 512-903-5442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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