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General NPI Number Information
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NPI Number | 1952716698
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Entity Type | Organization
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Legal Business Name | RESTORE FUNCTIONAL RESTORATION, LLC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 20002 N 19TH AVE # B100
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City | PHOENIX
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State | AZ
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Zip | 85027-4250
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Country | US
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Telephone | 602-714-1408
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Fax | 888-468-7614
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Provider Business Mailing Address
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Address Line | 20002 N 19TH AVE # B100
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City | PHOENIX
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State | AZ
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Zip | 85027-4250
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Country | US
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Telephone | 602-714-1408
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Fax | 888-468-7614
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Authorized Official
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Title or Position | OWNER/COO
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Name | AMY RICHTER BODE
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Credential |
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Telephone | 602-403-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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