| NPI | 1356001721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA ADAMS Manager 480-306-6627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2024-09-26 |