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General NPI Number Information
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NPI Number | 1740159185
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Entity Type | Organization
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Legal Business Name | RESTORE PT
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1533 MEMORIAL DR
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City | OAKLAND
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State | MD
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Zip | 21550-4338
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Country | US
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Telephone | 301-616-6241
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Fax |
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Provider Business Mailing Address
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Address Line | 389 DENNETT RD
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City | OAKLAND
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State | MD
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Zip | 21550-1469
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Country | US
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Telephone | 301-616-6241
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JAIDEN TODD
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Credential | PT, DPT
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Telephone | 301-616-6241
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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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