Provider Demographics
NPI:1730868415
Name:RESTORATIVE THERAPEUTICS, LLC.
Entity type:Organization
Organization Name:RESTORATIVE THERAPEUTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:TN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMBT, MMP
Authorized Official - Phone:919-503-7483
Mailing Address - Street 1:3243 BRIERHILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27562-9360
Mailing Address - Country:US
Mailing Address - Phone:919-503-7483
Mailing Address - Fax:
Practice Address - Street 1:14 CONSULTANT PL STE 250
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6320
Practice Address - Country:US
Practice Address - Phone:919-339-1835
Practice Address - Fax:919-629-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811347842OtherMASSAGE