Organization
RESTORACARE, INC.
Active
Organization
RESTORACARE, INC.
Active
Other names
At Home Med Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LANCE PHILLIP VAN ARSDELL P.T. (PRESIDENT)
(602) 619-8582
Entity
Organization
Contact information
Practice address
6303 E MALLORY ST, MESA, AZ 85215-2114
(602) 619-8582
(480) 654-0054
Mailing address
5901 E MCKELLIPS RD # 109-321, MESA, AZ 85215-2700
(602) 619-8582
(480) 654-0054
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
726052
—
AZ
01
—
AZ0460670
BCBS PT AND OT BILLING #
AZ
Enumeration date
05/26/2006
Last updated
07/07/2009
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