Provider Demographics
NPI:1487077145
Name:RESTORATIVE THERAPY SPECIALISTS, PLLC
Entity type:Organization
Organization Name:RESTORATIVE THERAPY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGBOTTOM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, NCS
Authorized Official - Phone:509-388-2270
Mailing Address - Street 1:1608 S 24TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5719
Mailing Address - Country:US
Mailing Address - Phone:509-388-2270
Mailing Address - Fax:509-320-4109
Practice Address - Street 1:1608 S 24TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5719
Practice Address - Country:US
Practice Address - Phone:509-388-2270
Practice Address - Fax:509-320-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000062432251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811251861OtherINDIVIDUAL NPI