Organization
RESTORE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL BLACKBURN (OWNER)
(469) 256-6661
Entity
Organization
Contact information
Practice address
158 AZTEC LN STE 104, VAN ALSTYNE, TX 75495-3451
(903) 227-1527
Mailing address
PO BOX 191088, DALLAS, TX 75219-8088
(469) 256-6661
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
04/29/2022
Last updated
10/12/2022
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