MEDICARE: RESTORATIVE HEALTH, LLC

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	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1790303196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE HEALTH, LLC

Provider Business Mailing Address
First Line	:	21510 PALARAMO CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-7164
Country	:	US
Telephone Number	:	832-489-7207
Fax Number	:

Provider Business Practice Location Address
First Line	:	4654 HIGHWAY 6 N STE 308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-2879
Country	:	US
Telephone Number	:	832-489-7207
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	THELMA MCRIPLEY
Credential	:
Telephone Number	:	832-489-7207

Provider Enumeration Date	:	07/12/2020
Last Update Date	:	01/25/2021

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