MEDICARE: RESTORE PHYSICAL THERAPY AND WELLNESS CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	17287	MA

General Provider Information

NPI Number	:	1093059354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE PHYSICAL THERAPY AND WELLNESS CENTER INC.

Provider Business Mailing Address
First Line	:	220 RUSSELL ST STE 400
Second Line	:
City	:	HADLEY
State	:	MA
Zip	:	01035-9542
Country	:	US
Telephone Number	:	413-387-0722
Fax Number	:	413-387-0723

Provider Business Practice Location Address
First Line	:	220 RUSSELL ST
Second Line	:	SUITE 400
City	:	HADLEY
State	:	MA
Zip	:	01035-9542
Country	:	US
Telephone Number	:	413-387-0722
Fax Number	:	413-387-0723

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/ OWNER
Name	:	DR. PATRICIA JULIE YOUNG
Credential	:	DPT
Telephone Number	:	413-387-0722

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	03/14/2016

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