# RESTORE VITALITY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Restore Vitality Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447767181
- **Authorized official:** MR. MICHAEL NELSON (OWNER/MEMBER)
- **Authorized official phone:** (602) 814-2559

## Contact information

- **Practice address:** 8133 W HEATHERBRAE DR, PHOENIX, AZ 85033-2336
- **Practice address phone:** (602) 814-2559
- **Mailing address:** 8133 W HEATHERBRAE DR, PHOENIX, AZ 85033-2336
- **Mailing address phone:** (602) 814-2559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133NN1002X | Nutrition Education Nutritionist | — | AZ | — |
| 204R00000X | Electrodiagnostic Medicine Physician | — | AZ | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | AZ | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | AZ | — |
| 207RG0100X | Gastroenterology Physician | — | AZ | — |
| 2081N0008X | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician | — | AZ | — |

## Other

- **Enumeration date:** 01/03/2018
- **Last updated:** 01/03/2018