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General NPI Number Information
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NPI Number | 1649997453
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Entity Type | Organization
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Legal Business Name | RESTORATION CLINIC FREMONT
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 4535 MATTOS DR
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City | FREMONT
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State | CA
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Zip | 94536-6736
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Country | US
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Telephone | 888-907-9770
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 N CENTRAL AVE STE 1000
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City | PHOENIX
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State | AZ
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Zip | 85004-4509
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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 | BILLING MANAGER
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Name | HENRY H ASHBY
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Credential |
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Telephone | 888-907-9770
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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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