NPIMap

Organization Active NPI

Restore Therapy Services LLC

  • Occupational Therapist
  • Gary, IN
National Provider Identifier
1932494424
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
31001112A Issued in IN
Legal business name
RESTORE THERAPY SERVICES LLC
Practice address
6100 Miller Avenue
Gary, IN 46403
Phone
(219) 427-0196
Fax
(219) 427-0197
NPI assigned
Jun 13, 2011
Last updated
Mar 15, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Authorized official

Name
Brekell Vales
Title
Human Resorces
Phone
(219) 427-0196

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05002122A IN
Respiratory/Developmental/Rehabilitative Specialist/Technologist 225500000X 22003661A IN
Occupational Therapist 225X00000X 31001112A IN Primary
Occupational Therapist 225X00000X 31004535A IN

Addresses

Primary practice location

6100 Miller Avenue
Gary, IN 46403

Mailing address

6100 Miller Avenue
Gary, IN 46403
Phone (219) 427-0196

Other names 1

  • Next Level Therapy Services LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110920000164 IN Part B Supplier - Clinic/Group Practice 5991976177 Receives reassigned benefits from 2 practitioners
Practice locations: Gary, IN

National Provider Directory

National Provider Directory

Locations

6100 Miller Ave
Gary, IN 46403
Phone (219) 427-0196

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1307923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1932494424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 MILLER AVENUE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "46403",
            "telephone_number": "219-427-0196",
            "fax_number": "219-427-0197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 MILLER AVENUE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "46403",
            "telephone_number": "219-427-0196",
            "fax_number": "219-427-0197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE THERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-13",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "VALES",
        "authorized_official_first_name": "BREKELL",
        "authorized_official_title_or_position": "HUMAN RESORCES",
        "authorized_official_telephone_number": "219-427-0196"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05002122A",
            "primary": false
        },
        {
            "code": "225500000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist",
            "state": "IN",
            "license": "22003661A",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31001112A",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31004535A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Next Level Therapy Services LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Gary, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; 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.