NPIMap

Organization Active NPI

The Restoration Space LLC

  • Physical Therapist
  • Bethlehem, PA
National Provider Identifier
1063927978
Registry record updated Dec 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
THE RESTORATION SPACE LLC
Practice address
406 Delaware Ave Ste 104
Bethlehem, PA 18015-1469
Phone
(610) 594-2060
NPI assigned
Dec 14, 2017
Last updated
Dec 14, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2017

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

Authorized official

Name
Megan B Eyvazzadeh, DPTNPI 1942527379
Title
Owner
Phone
(610) 594-2060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

406 Delaware Ave Ste 104
Bethlehem, PA 18015-1469

Mailing address

406 Delaware Ave Ste 104
Bethlehem, PA 18015-1469

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180221000056 PA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698036317 Receives reassigned benefits from 10 practitioners
Practice locations: Bethlehem, PA

National Provider Directory

National Provider Directory

Locations

406 Delaware Ave
Ste 2
Bethlehem, PA 18015
Phone (610) 867-5260

406 Delaware Ave
Ste 4
Bethlehem, PA 18015
Phone (484) 241-4220

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1513209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513209600000",
    "number": "1063927978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 DELAWARE AVE STE 104",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 DELAWARE AVE STE 104",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151469",
            "telephone_number": "610-594-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RESTORATION SPACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-14",
        "last_updated": "2017-12-14",
        "status": "A",
        "authorized_official_last_name": "EYVAZZADEH",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-594-2060",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; 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.