Active NPI
Restore Therapy Group
- Clinical Social Worker
- Germantown, TN
National Provider Identifier
1740066331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Legal business name
- RESTORE THERAPY GROUP
- Practice address
- 2583 Turpins Glen Dr
Germantown, TN 38138-5820 - Phone
- (901) 318-0506
- NPI assigned
- Sep 7, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kimberly H Dafferner, LCSW
- Title
- Co-Owner/Founder
- Phone
- (901) 318-0506
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
2583 Turpins Glen Dr
Germantown, TN 38138-5820
Mailing address
2583 Turpins Glen Dr
Germantown, TN 38138-5820
Phone (901) 318-0506
Other practice location 1
1612 Painted Horse Pass
Collierville, TN 38017-2405
Phone (901) 825-1778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN, MS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231212001591 | TN | Part B Supplier - Clinic/Group Practice | 5294184552 |
Receives reassigned benefits from 5 practitioners Practice locations: Germantown, TN |
| O20240312001048 | MS | Part B Supplier - Clinic/Group Practice | 5294184552 |
Receives reassigned benefits from 9 practitioners Practice locations: Iuka, MS |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 13
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Social Worker
- Collierville, TN
- NPI 1851777270
Clinical, MS, TN
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694044800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1711584000000",
"number": "1740066331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2583 TURPINS GLEN DR",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381385820",
"telephone_number": "901-318-0506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2583 TURPINS GLEN DR",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381385820",
"telephone_number": "901-318-0506"
}
],
"practiceLocations": [
{
"address_1": "1612 Painted Horse Pass",
"address_purpose": "LOCATION",
"city": "Collierville",
"state": "TN",
"postal_code": "380172405",
"country_code": "US",
"telephone_number": "901-825-1778",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "RESTORE THERAPY GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2023-09-07",
"last_updated": "2024-03-28",
"certification_date": "2024-03-28",
"status": "A",
"authorized_official_last_name": "DAFFERNER",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "CO-OWNER/FOUNDER",
"authorized_official_telephone_number": "901-318-0506",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "LCSW"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.