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General NPI Number Information
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NPI Number | 1356942742
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Entity Type | Organization
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Legal Business Name | RESTORE PELVIC HEALTH & REHAB LLC
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 301 E YAMATO RD STE 1240
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City | BOCA RATON
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State | FL
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Zip | 33431-4931
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Country | US
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Telephone | 914-447-1792
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Fax |
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Provider Business Mailing Address
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Address Line | 7641 NE MORNINGSIDE TER
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City | BOCA RATON
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State | FL
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Zip | 33487-1726
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Country | US
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Telephone | 914-447-1792
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. VICTORIA MALLOW
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Credential | PT, DPT
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Telephone | 914-447-1792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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