Provider Demographics
NPI:1730439902
Name:RESTAR, MARY JUNE (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY JUNE
Middle Name:
Last Name:RESTAR
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 1:390 NEW CAMP RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4085
Mailing Address - Country:US
Mailing Address - Phone:606-237-1167
Mailing Address - Fax:
Practice Address - Street 1:26901 US HWY 119 S
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514
Practice Address - Country:US
Practice Address - Phone:606-237-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist