Restorative Women'S Wellness, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

AT-255 Issued in ID

Legal business name

RESTORATIVE WOMEN'S WELLNESS, LLC

Practice address

2525 N Stokesberry PL Unit a
Meridian, ID 83646-1510

Phone

(208) 378-1517

Fax

(208) 939-8597

NPI assigned

Sep 7, 2005

Organization subpart

No

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

Authorized official

Name

Charity Kristin Berrier, ATC, NTP, LMT

Title

Owner

Phone

(208) 866-6549

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491436800000",
    "number": "1366436313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 N STOKESBERRY PL UNIT A",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836461510",
            "telephone_number": "208-378-1517",
            "fax_number": "208-939-8597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 N STOKESBERRY PL UNIT A",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836461510",
            "telephone_number": "208-378-1517",
            "fax_number": "208-939-8597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATIVE WOMEN'S WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2017-04-06",
        "status": "A",
        "authorized_official_last_name": "BERRIER",
        "authorized_official_first_name": "CHARITY",
        "authorized_official_middle_name": "KRISTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-866-6549",
        "authorized_official_credential": "ATC, NTP, LMT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "AT-255",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-255",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2017; 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.