| NPI | 1568072387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HALEIGH SHEREE MERSHON Director Of Revenue 480-878-4806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251S0007X Physical Therapist, Sports | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2020-08-06 |