| NPI | 1255754354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BASTEN Owner 480-689-5515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2022-07-18 |