| NPI | 1194929158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ELLIS LEE Owner 480-644-0644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 111N00000X Chiropractor |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2007-07-10 |