Provider Demographics
NPI:1043879174
Name:RESTORATION BODYWORKS, PLLC
Entity type:Organization
Organization Name:RESTORATION BODYWORKS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:LANIER
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-903-5442
Mailing Address - Street 1:PO BOX 262294
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2294
Mailing Address - Country:US
Mailing Address - Phone:512-903-5442
Mailing Address - Fax:
Practice Address - Street 1:2116 HEATHER HILL LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-2942
Practice Address - Country:US
Practice Address - Phone:512-903-5442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty