Restore Physical Therapy and Wellness LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT007124 Issued in GA

Legal business name

RESTORE PHYSICAL THERAPY AND WELLNESS LLC

Practice address

415 Bellflower CT
Roswell, GA 30076-3369

Phone

(678) 491-4729

NPI assigned

Dec 12, 2010

Last updated

Jan 11, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shannon Ward Henne, PTNPI 1073700811

Title

President

Phone

(678) 491-4729

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• Shannon Ward Henne, PT

  • Physical Therapist
  • Jacksonville Beach, FL
  • NPI 1073700811
  NPD (past) Authorized official
• Amy Watson Hinkel, P.T.

  • Physical Therapist
  • Roswell, GA
  • NPI 1184997272
  NPD (past)
• Blair A Holliday, MSPT

  • Physical Therapist
  • Atlanta, GA
  • NPI 1891001558
  NPD (past)

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

{
    "created_epoch": "1292112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294704000000",
    "number": "1073816112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 BELLFLOWER CT",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300763369",
            "telephone_number": "678-491-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 BELLFLOWER CT",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300763369",
            "telephone_number": "678-491-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE PHYSICAL THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-12",
        "last_updated": "2011-01-11",
        "status": "A",
        "authorized_official_last_name": "HENNE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "WARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-491-4729",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT007124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Roswell, GA
• Providers in Roswell, GA by specialty
• Physical Therapy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.