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General NPI Number Information
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NPI Number | 1851912885
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Entity Type | Organization
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Legal Business Name | RESTORED THERAPY AND WELLNESS, LLC
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 9372 CANTER DR
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City | ELK GROVE
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State | CA
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Zip | 95624-9461
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Country | US
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Telephone | 301-452-4261
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 311
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City | GLENELG
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State | MD
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Zip | 21737-0311
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Country | US
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Telephone | 301-452-4261
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADINA VERRETT MYLES
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Credential | PT
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Telephone | 301-452-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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