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General NPI Number Information
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NPI Number | 1497557185
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Entity Type | Organization
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Legal Business Name | CORE RESTORE NUTRITION AND WELLNESS LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 79 LAKE AVE APT 1
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2474
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Country | US
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Telephone | 518-332-2738
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Fax |
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Provider Business Mailing Address
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Address Line | 79 LAKE AVE APT 1
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2474
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Country | US
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Telephone | 518-332-2738
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Fax |
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Authorized Official
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Title or Position | CERTIFIED NUTRITION SPECIALIST
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Name | SARA BROWN
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Credential | CNS, DPT
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Telephone | 518-332-2738
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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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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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