Healthcare Provider Details

I. General information

NPI: 1578519062
Provider Name (Legal Business Name): RESTORACARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 E MALLORY ST
MESA AZ
85215-2114
US

IV. Provider business mailing address

5901 E MCKELLIPS RD # 109-321
MESA AZ
85215-2700
US

V. Phone/Fax

Practice location:
  • Phone: 602-619-8582
  • Fax: 480-654-0054
Mailing address:
  • Phone: 602-619-8582
  • Fax: 480-654-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. LANCE PHILLIP VAN ARSDELL
Title or Position: PRESIDENT
Credential: P.T.
Phone: 602-619-8582