MEDICARE: RESTORE PHYSICAL THERAPY, 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	225100000X	Physical Therapist	PT-007826L	PA

General Provider Information

NPI Number	:	1992045892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	56 MONTRAVER DR
Second Line	:
City	:	MONESSEN
State	:	PA
Zip	:	15062-2036
Country	:	US
Telephone Number	:	724-684-4036
Fax Number	:	724-684-4036

Provider Business Practice Location Address
First Line	:	1575 GRAND BLVD
Second Line	:
City	:	MONESSEN
State	:	PA
Zip	:	15062-2262
Country	:	US
Telephone Number	:	412-551-8229
Fax Number	:	724-614-7314

Authorized Official
Title or Position	:	OWNER
Name	:	CRAIG A RICE
Credential	:	P.T.
Telephone Number	:	412-551-8229

Provider Enumeration Date	:	03/01/2013
Last Update Date	:	03/31/2015

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