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General NPI Number Information
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NPI Number | 1861190555
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Entity Type | Organization
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Legal Business Name | RESTORE 35
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 3735 PALOMAR CENTRE DR STE 280
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City | LEXINGTON
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State | KY
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Zip | 40513-1187
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Country | US
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Telephone | 859-374-1994
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Fax |
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Provider Business Mailing Address
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Address Line | 3735 PALOMAR CENTRE DR STE 280
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City | LEXINGTON
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State | KY
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Zip | 40513-1187
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CALLIE SHORT
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Credential | DC
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Telephone | 859-583-3842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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