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General NPI Number Information
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NPI Number | 1548199730
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Entity Type | Organization
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Legal Business Name | RAPID RESTORE PLASTIC & RECONSTRUCTIVE TRAUMA SURGERY, PLLC
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 1900 E STATE HIGHWAY 114 STE 140
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6510
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Country | US
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Telephone | 469-293-2533
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 E STATE HIGHWAY 114 STE 140
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6510
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Country | US
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Telephone | 469-293-2533
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ALI REZA ABTAHI
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Credential | DO
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Telephone | 469-293-2533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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