MEDICARE: MRS. DANIELLE RESTIVO DPT

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	225100000X	Physical Therapist	40QA011459	NJ

General Provider Information

NPI Number	:	1679607915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE RESTIVO DPT

Provider Business Mailing Address
First Line	:	630 SUSAN LN
Second Line	:
City	:	BRIELLE
State	:	NJ
Zip	:	08730-1736
Country	:	US
Telephone Number	:	732-276-5846
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 MAIN STREET
Second Line	:	SUITE 1
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720
Country	:	US
Telephone Number	:	732-807-4702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	09/03/2021

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