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General NPI Number Information
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NPI Number | 1770955312
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Entity Type | Organization
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Legal Business Name | RESTORATIVE PHYSICAL THERAPY & WELLNESS LLC
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 900 STANHOPE GDNS SUITE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-842-6562
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Fax |
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Provider Business Mailing Address
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Address Line | 900 STANHOPE GDNS STE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0755
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Country | US
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Telephone | 757-842-6562
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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 | MRS. ASHLEY NICOLE BALDWIN
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Credential | DPT
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Telephone | 757-842-6562
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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 | 2305206158
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License Number State | VA
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