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General NPI Number Information
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NPI Number | 1316176373
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Entity Type | Organization
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Legal Business Name | RESTORE THERAPY SERVICES
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 430 RIVERS AVE
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City | EUFAULA
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State | AL
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Zip | 36027-1820
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Country | US
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Telephone | 334-687-6627
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Fax | 334-687-5913
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Provider Business Mailing Address
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Address Line | 306 RIVERS AVE APT C4
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City | EUFAULA
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State | AL
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Zip | 36027-1842
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Country | US
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Telephone | 334-687-1847
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPY
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Name | SHARON J. BURCH
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Credential |
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Telephone | 334-687-1847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2870
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License Number State | AL
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