| NPI | 1710171558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK MORTENSEN Owner 480-607-9779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 225100000X Physical Therapist | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-09-05 |