Organization
RESTORE VASCULAR PLLC
Active
Organization
RESTORE VASCULAR PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN IAN WELLER (OWNER)
(480) 874-6808
Entity
Organization
Contact information
Practice address
18510 E SAN TAN BLVD STE 115, QUEEN CREEK, AZ 85142-2206
(480) 442-3990
Mailing address
18510 E SAN TAN BLVD STE 115, QUEEN CREEK, AZ 85142-2206
(480) 442-3990
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
202K00000X
Phlebology Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
11/07/2022
Last updated
08/29/2023
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