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General NPI Number Information
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NPI Number | 1831651678
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Entity Type | Organization
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Legal Business Name | RESTORATION PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 4020 W PALM AIRE DR APT 201
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City | POMPANO BEACH
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State | FL
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Zip | 33069-4159
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Country | US
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Telephone | 954-860-3117
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Fax |
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Provider Business Mailing Address
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Address Line | 2637 E ATLANTIC BLVD # 1064
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4939
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Country | US
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Telephone | 954-860-3117
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | ROMAN JURKIEWICZ
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Credential | PT
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Telephone | 954-860-3117
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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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