1619576907 NPI number — RESTORATIVE MANUAL PHYSICAL THERAPY & FITNESS LLC

Table of content: BAILEY ELIZABETH CARVER LCSW (NPI 1629754247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619576907 NPI number — RESTORATIVE MANUAL PHYSICAL THERAPY & FITNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORATIVE MANUAL PHYSICAL THERAPY & FITNESS LLC
Provider Last Name:
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Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1619576907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3521 WILSHIRE WAY APT 4123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75082-0080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-233-4298
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 W PLANO PKWY STE 141A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-8969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-398-0789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/OWNER
Authorized Official Telephone Number:
216-233-4298

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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