MEDICARE: RESTORE INTEGRATIVE HEALTH PLLC

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	175F00000X	Naturopath

General Provider Information

NPI Number	:	1770305039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE INTEGRATIVE HEALTH PLLC

Provider Business Mailing Address
First Line	:	1210 TACOMA AVE S APT 506
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98402-2023
Country	:	US
Telephone Number	:	360-447-8486
Fax Number	:	206-339-1628

Provider Business Practice Location Address
First Line	:	1944 PACIFIC AVE STE 301A
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98402-3121
Country	:	US
Telephone Number	:	360-447-8486
Fax Number	:	206-339-1628

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUTTINEE HANNAH SANSAVATH
Credential	:	ND
Telephone Number	:	360-447-8486

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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