Provider Demographics
NPI:1891191573
Name:RESTORE FOOT AND ANKLE PC
Entity Type:Organization
Organization Name:RESTORE FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RESENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-226-8199
Mailing Address - Street 1:PO BOX 120102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-0102
Mailing Address - Country:US
Mailing Address - Phone:817-226-8199
Mailing Address - Fax:
Practice Address - Street 1:701 TUSCAN DR STE 220
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3838
Practice Address - Country:US
Practice Address - Phone:972-432-9191
Practice Address - Fax:972-432-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1822213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P2P3OtherTXBCBS GROUP #
TX420960Medicare PIN