Provider Demographics
NPI:1679607915
Name:RESTIVO, DANIELLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:RESTIVO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SUSAN LN
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1736
Mailing Address - Country:US
Mailing Address - Phone:732-276-5846
Mailing Address - Fax:
Practice Address - Street 1:2 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720
Practice Address - Country:US
Practice Address - Phone:732-807-4702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA011459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist