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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