MEDICARE: RESTORATION THERAPIES

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	171W00000X	Contractor	MA60178088	WA

General Provider Information

NPI Number	:	1538564695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION THERAPIES

Provider Business Mailing Address
First Line	:	PO BOX 7186
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-0930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 SW SEDGWICK RD
Second Line	:	SUITE 101
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-6425
Country	:	US
Telephone Number	:	360-860-0589
Fax Number	:

Authorized Official
Title or Position	:	OWNDER
Name	:	MICHELE A LEWIS
Credential	:	LMP
Telephone Number	:	360-860-0589

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	10/30/2014

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Directions to “RESTORATION THERAPIES ” Practice Location

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