Healthcare Provider Details

I. General information

NPI: 1073404703
Provider Name (Legal Business Name): RESTORE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6712 RESTORACY DR
WHITESTOWN IN
46075-0089
US

IV. Provider business mailing address

240 E CITY CENTER DR
CARMEL IN
46032-3327
US

V. Phone/Fax

Practice location:
  • Phone: 317-506-1370
  • Fax:
Mailing address:
  • Phone: 317-506-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KARA RIDDELL
Title or Position: CONTROLLER
Credential:
Phone: 317-217-8601