NPIMap

Organization Active NPI

Restore Physical Therapy, LLC

  • Physical Therapist
  • Jesup, GA
National Provider Identifier
1306331756
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT011768 Issued in GA
Legal business name
RESTORE PHYSICAL THERAPY, LLC
Practice address
430 W Cherry St
Jesup, GA 31545-1435
Phone
(912) 294-1302
NPI assigned
Jun 28, 2018
Organization subpart
Yes
Parent organization
RESTORE PHYSICAL THERAPY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Authorized official

Name
Mrs. Holli Joy Stevens, DPTNPI 1841680972
Title
Business Manager
Phone
(912) 256-5610

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT011768 GA Primary

Addresses

Primary practice location

430 W Cherry St
Jesup, GA 31545-1435

Mailing address

430 W Cherry St
Jesup, GA 31545-1435
Phone (912) 256-5610

Other practice location 1

1225 F Northway
Darien, GA 31305-3130
Phone (912) 437-2869

Other names 2

  • FYZICAL Therapy & Balance Center Doing business as
  • Fyzical Therapy & Balance Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180912001130 GA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7810247848 Receives reassigned benefits from 10 practitioners
Practice locations: Baxley, GA; Darien, GA; Jesup, GA; Vidalia, GA

National Provider Directory

National Provider Directory
Part of
Restore Physical Therapy LLC

Locations

118 Azalea Rd
Ste 11
Baxley, GA 31513
Phone (912) 245-2855

430 W Cherry St
Jesup, GA 31545
Phone (912) 256-4392

Practitioners & affiliated clinicians

Practitioners 12

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": "1530144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1306331756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W CHERRY ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315451435",
            "telephone_number": "912-256-5610",
            "fax_number": "912-559-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W CHERRY ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315451435",
            "telephone_number": "912-294-1302"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 F Northway",
            "address_purpose": "LOCATION",
            "city": "Darien",
            "state": "GA",
            "postal_code": "313053130",
            "country_code": "US",
            "telephone_number": "912-437-2869",
            "fax_number": "912-437-2873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RESTORE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RESTORE PHYSICAL THERAPY, LLC",
        "enumeration_date": "2018-06-28",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-07",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "HOLLI",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "912-256-5610",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT011768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FYZICAL Therapy & Balance Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FYZICAL Therapy & Balance Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fyzical Therapy & Balance Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jesup, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.