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General NPI Number Information
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NPI Number | 1083266191
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Entity Type | Organization
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Legal Business Name | RESTORE THERAPY CENTER, LLC
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 4210 LOMAC ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-2817
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Country | US
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Telephone | 334-425-8063
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Fax |
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Provider Business Mailing Address
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Address Line | 4210 LOMAC ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-2817
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Country | US
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Telephone | 334-425-8063
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLEY REHM
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Credential |
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Telephone | 343-425-8063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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