Provider Demographics
NPI:1386136182
Name:RESTORE MEDICAL PLLC
Entity type:Organization
Organization Name:RESTORE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-668-4172
Mailing Address - Street 1:3337 N MILLER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6496
Mailing Address - Country:US
Mailing Address - Phone:760-668-4172
Mailing Address - Fax:
Practice Address - Street 1:3337 N MILLER RD STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6496
Practice Address - Country:US
Practice Address - Phone:760-668-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty