| NPI | 1114274784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERGIO IVAN MACIAS Owner 928-722-6050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 4229) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ C001071) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2024-04-01 |