1699868349 NPI number — RESTORATIVE THERAPIES, INC

Table of content: (NPI 1699868349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699868349 NPI number — RESTORATIVE THERAPIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORATIVE THERAPIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699868349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8098 SANDPIPER CIR STE M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOTTINGHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236-4928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-609-9166
Provider Business Mailing Address Fax Number:
443-835-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8098 SANDPIPER CIR STE M
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOTTINGHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-609-9166
Provider Business Practice Location Address Fax Number:
410-878-2466
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JANICKI
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
800-609-9166

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ----------------- , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: .................... . This is a "DEPARTMENT OF VETERANS AFFAIRS - CONTRACT AWARDED" identifier . This identifiers is of the category "OTHER".
  • Identifier: .................... , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: .................... , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: .................... . This is a "MARYLAND RESIDENTIAL SERVICE AGENCY LICENSE FOR DURABLE MEDICAL EQUIPMENT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: .................... , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: .................... , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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