Organization
LIFE RESTORATION PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE GERMANY PA-C (PHYSICIAN ASSISTANT)
(405) 488-7543
Entity
Organization
Contact information
Practice address
1211 N SHARTEL AVE STE 801, OKLAHOMA CITY, OK 73103-2425
(405) 504-5433
Mailing address
14433 LOCUST ST, PIEDMONT, OK 73078-8910
(405) 488-7543
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225700000X
Massage Therapist
—
—
225X00000X
Occupational Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/05/2021
Last updated
08/05/2021
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