Organization
RESTORE PELVIC PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENE SHIROKOBROD DPT (CEO)
(410) 736-3572
Entity
Organization
Contact information
Practice address
5130 DORSEY HALL DR FL 1, ELLICOTT CITY, MD 21042-7870
(443) 864-4980
Mailing address
722 E WATERSVILLE RD, MOUNT AIRY, MD 21771-3519
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/07/2020
Last updated
10/07/2020
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