MEDICARE: REGULATE & RESTORE THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1194674523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGULATE & RESTORE THERAPY LLC

Provider Business Mailing Address
First Line	:	777 N JEFFERSON ST STE 408
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3875
Country	:	US
Telephone Number	:	262-228-4864
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 N JEFFERSON ST STE
Second Line	:	SUITE 408 PMB1158
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3875
Country	:	US
Telephone Number	:	262-228-4864
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	TANYA EDWARDS
Credential	:	LCSW
Telephone Number	:	262-228-4864

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	02/18/2026

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