Provider Demographics
NPI:1942948427
Name:RESTORE PELVIC HEALTH PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:RESTORE PELVIC HEALTH PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:205-492-3216
Mailing Address - Street 1:1314 WESTGATE PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2154
Mailing Address - Country:US
Mailing Address - Phone:205-492-3216
Mailing Address - Fax:
Practice Address - Street 1:1314 WESTGATE PKWY STE 7
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2154
Practice Address - Country:US
Practice Address - Phone:205-492-3216
Practice Address - Fax:334-268-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty