MEDICARE: RESTORATION PHYSICAL THERAPY

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

General Provider Information

NPI Number	:	1831651678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	2637 E ATLANTIC BLVD # 1064
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4939
Country	:	US
Telephone Number	:	954-860-3117
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 W PALM AIRE DR APT 201
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-4159
Country	:	US
Telephone Number	:	954-860-3117
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/PHYSICAL THERAPIST
Name	:	ROMAN JURKIEWICZ
Credential	:	PT
Telephone Number	:	954-860-3117

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	09/09/2019

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Directions to “RESTORATION PHYSICAL THERAPY ” Practice Location

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