| NPI | 1437583853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY DEWOLF Owner 480-282-8485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: AZ 7685) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 4369) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2013-08-22 |