Provider Demographics
NPI:1902558562
Name:RESTORATIVE PHYSIO, PLLC
Entity Type:Organization
Organization Name:RESTORATIVE PHYSIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:STOKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-366-9483
Mailing Address - Street 1:515 W JANEAUX ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2931
Mailing Address - Country:US
Mailing Address - Phone:406-366-9483
Mailing Address - Fax:
Practice Address - Street 1:515 W JANEAUX ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2931
Practice Address - Country:US
Practice Address - Phone:406-366-9483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty