Provider Demographics
NPI:1841043767
Name:RESTORE FOOT & ANKLE SPECIALISTS PLLC
Entity type:Organization
Organization Name:RESTORE FOOT & ANKLE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:SIRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POKALA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:682-551-7474
Mailing Address - Street 1:4801 HIGH RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-2425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 W 15TH ST STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5826
Practice Address - Country:US
Practice Address - Phone:682-551-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty