Provider Demographics
NPI:1356403422
Name:RESTIFICAR, DAPHNE ROSE (PT)
Entity type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:ROSE
Last Name:RESTIFICAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 E AILSIE AVE
Mailing Address - Street 2:APARTMENT 6D
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-6795
Mailing Address - Country:US
Mailing Address - Phone:361-593-3322
Mailing Address - Fax:361-593-3234
Practice Address - Street 1:1357 N ARMSTRONG
Practice Address - Street 2:TEXAS A & M UNIVERSITY
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363
Practice Address - Country:US
Practice Address - Phone:361-593-3322
Practice Address - Fax:361-593-3234
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist