MEDICARE: COG RESTORE, LLC

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1194108761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COG RESTORE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11567
Second Line	:
City	:	ST THOMAS
State	:	VI
Zip	:	00801-4567
Country	:	US
Telephone Number	:	340-779-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	9053 ESTATE THOMAS
Second Line	:	ROYAL PALM PROFESSIONAL BUILDING, STE 206
City	:	ST THOMAS
State	:	VI
Zip	:	00802
Country	:	US
Telephone Number	:	340-779-9355
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN CARLOS BACOT
Credential	:	MD
Telephone Number	:	340-779-2663

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	03/04/2026

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Directions to “COG RESTORE, LLC ” Practice Location

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