Organization Name: | RESTORE THERAPY AND WELLNESS, INC. |
NPI Number: | 1245590918 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JONATHAN NICHOLAS KOLMETZ (PRESIDENT) |
Mailing Address: | 877 Third Street Suite 1 Chipley |
State: | FL US |
Postal Code: | 32428 |
Phone Number: | 8506388447 |
Fax Number: | 8506389217 |
NPI Enumeration Date: | 05/29/2012 |
NPI Last Update Date: | 05/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |