NPIMap

Organization Active NPI

Restoration Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Media, PA
National Provider Identifier
1174826184
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
018385 Issued in PA
Legal business name
RESTORATION PHYSICAL THERAPY LLC
Practice address
203 E Baltimore Avenue
Media, PA 19063-3433
Phone
(610) 565-0670
Fax
(610) 565-7706
NPI assigned
Dec 13, 2010
Last updated
Jun 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

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

Authorized official

Name
Mrs. Mary Ellen Dougherty, MSPTNPI 1518057900
Title
Physical Therapist
Phone
(610) 565-0670

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 Therapy Clinic/Center 261QP2000X 018385 PA Primary

Addresses

Primary practice location

203 E Baltimore Avenue
Media, PA 19063-3433

Mailing address

203 E Baltimore Ave
Media, PA 19063-3433
Phone (610) 565-0670

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151203001398 PA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4284818956 Receives reassigned benefits from 3 practitioners
Practice locations: Media, PA

National Provider Directory

National Provider Directory

Locations

203 E Baltimore Ave
Media, PA 19063
Phone (610) 565-0670

203 E Baltimore Ave
Ste 2
Media, PA 19063
Phone (610) 565-0670

Practitioners & affiliated clinicians

Practitioners 9

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": "1292198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465776000000",
    "number": "1174826184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 E BALTIMORE AVE",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190633433",
            "telephone_number": "610-565-0670",
            "fax_number": "610-565-7706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 E BALTIMORE AVENUE",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190633433",
            "telephone_number": "610-565-0670",
            "fax_number": "610-565-7706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-13",
        "last_updated": "2016-06-13",
        "status": "A",
        "authorized_official_last_name": "DOUGHERTY",
        "authorized_official_first_name": "MARY ELLEN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "610-565-0670",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "PA",
            "license": "018385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Media, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; 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.