Healthcare Provider Details

I. General information

NPI: 1134044357
Provider Name (Legal Business Name): RESTORED WELLNESS & RECOVERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 LOST TREE RD
WILMINGTON NC
28411-9159
US

IV. Provider business mailing address

7601 LOST TREE RD
WILMINGTON NC
28411-9159
US

V. Phone/Fax

Practice location:
  • Phone: 910-227-9956
  • Fax: 910-202-6475
Mailing address:
  • Phone: 910-227-9956
  • Fax: 910-202-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ANGELA BOOTH
Title or Position: MANAGING MEMBER
Credential: PA-C
Phone: 910-227-9956