Restorative Physical Therapy, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

RESTORATIVE PHYSICAL THERAPY, PLLC

Practice address

604 Davis St
Evanston, IL 60201-4543

Phone

(847) 287-2659

NPI assigned

Mar 16, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melissa D GoldbergNPI 1760986103

Title

Owner

Phone

(847) 220-4260

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melissa D Goldberg, DPT

  • Physical Therapist
  • Evanston, IL
  • NPI 1760986103
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1053012898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 DAVIS ST FL 1",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014544",
            "telephone_number": "847-220-4260",
            "fax_number": "847-748-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 DAVIS ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014543",
            "telephone_number": "847-287-2659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATIVE PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-220-4260"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Resurraction Behavioral Health
• Resurrection
• Resurrection Senior Services
• Resurrection Services
• Resurrection Services

• Physical Therapy Clinic/Center in Evanston, IL
• Providers in Evanston, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.