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General NPI Number Information
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NPI Number | 1629191499
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Entity Type | Organization
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Legal Business Name | THE RESTORE GROUP LLC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 7400 S POWER RD BLDG 3 STE112
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City | GILBERT
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State | AZ
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Zip | 85297
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Country | US
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Telephone | 480-682-5460
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Fax | 480-682-5465
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Provider Business Mailing Address
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Address Line | 7400 S POWER RD BLDG 3 STE112
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City | GILBERT
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State | AZ
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Zip | 85297
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Country | US
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Telephone | 480-682-5460
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Fax | 480-682-5465
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | JAIME LINDLEY
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Credential |
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Telephone | 480-682-5460
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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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