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General NPI Number Information
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NPI Number | 1568700763
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Entity Type | Organization
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Legal Business Name | RESTORE PT & WELLNESS
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 44927 GEORGE WASHINGTON BLVD SUITE 210
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City | ASHBURN
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State | VA
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Zip | 20147-4295
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Country | US
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Telephone | 571-291-9936
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Fax | 571-918-4935
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Provider Business Mailing Address
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Address Line | 44927 GEORGE WASHINGTON BLVD SUITE 210
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City | ASHBURN
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State | VA
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Zip | 20147-4295
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIMBERLY A HORTON
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Credential | PT
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Telephone | 703-402-8536
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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 | 2305203754
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License Number State | VA
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