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General NPI Number Information
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NPI Number | 1851288971
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Entity Type | Organization
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Legal Business Name | RESTORE PHYSICAL THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 2835 VEROT SCHOOL RD STE B
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City | LAFAYETTE
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State | LA
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Zip | 70508-6411
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Country | US
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Telephone | 337-446-7918
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Fax | 337-201-9031
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Provider Business Mailing Address
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Address Line | 2835 VEROT SCHOOL RD STE B
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City | LAFAYETTE
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State | LA
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Zip | 70508-6411
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Country | US
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Telephone | 337-446-7918
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Fax | 337-201-9031
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | PHILLIP THIBODEAUX
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Credential | PT, DPT
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Telephone | 337-446-7918
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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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