MEDICARE: RESTORE

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	235Z00000X	Speech-Language Pathologist	11180	NC

General Provider Information

NPI Number	:	1447647920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE

Provider Business Mailing Address
First Line	:	4350 MAIN ST
Second Line	:
City	:	HARRISBURG
State	:	NC
Zip	:	28075-7433
Country	:	US
Telephone Number	:	704-559-9409
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 MAIN ST
Second Line	:
City	:	HARRISBURG
State	:	NC
Zip	:	28075-7433
Country	:	US
Telephone Number	:	704-559-9409
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHRIS JARRETT
Credential	:	CEO
Telephone Number	:	704-559-9409

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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Directions to “RESTORE ” Practice Location

Language	Start Address	Practice Location

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