Organization Active NPI

Restoration Physical Therapy, LLC.

  • Physical Therapy Clinic/Center
  • Hiram, GA
National Provider Identifier
1285842799
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
RESTORATION PHYSICAL THERAPY, LLC.
Practice address
5077 Jimmy Lee Smith Pkwy
Suite 119
Hiram, GA 30141
Phone
(770) 222-6621
Fax
(770) 222-8845
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Misti Nichole Barner, C.M.A.
Title
Office Manager
Phone
(770) 222-6621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

5077 Jimmy Lee Smith Pkwy
Suite 119
Hiram, GA 30141

Mailing address

5077 Jimmy Lee Smith Pkwy
Suite 119
Hiram, GA 30141
Phone (770) 222-6621

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050817001095 GA Part B Supplier - Clinic/Group Practice 9830129972 Receives reassigned benefits from 2 practitioners
Practice locations: Hiram, GA; Austell, GA

National Provider Directory

National Provider Directory

Locations

3961 Floyd Rd
Ste 200
Austell, GA 30106
Phone (770) 434-5111

5077 Jimmy Lee Smith Pkwy
Ste 119
Hiram, GA 30141
Phone (770) 222-6621

5077 Jimmy Lee Smith Pkwy
Ste 117
Hiram, GA 30141
Phone (770) 490-4341

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285842799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5077 JIMMY LEE SMITH PKWY",
            "address_2": "SUITE 119",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "30141",
            "telephone_number": "770-222-6621",
            "fax_number": "770-222-8845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5077 JIMMY LEE SMITH PKWY",
            "address_2": "SUITE 119",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "30141",
            "telephone_number": "770-222-6621",
            "fax_number": "770-222-8845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION PHYSICAL THERAPY, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BARNER",
        "authorized_official_first_name": "MISTI",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-222-6621",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "C.M.A."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hiram, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.