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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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