| NPI | 1699336313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREDENTIALING MANAGER Credentialing 602-385-2115 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery Hand Surgery |
| 207XX0005X Orthopaedic Surgery Sports Medicine | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2025-02-24 |