| NPI | 1962910281 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN D THOMPSON Manager 435-760-5896 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 46628) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8503) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 46628) | |
| 225100000X Physical Therapist (Licence: AZ 12547) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363A00000X Physician Assistant (Licence: AZ 5090) | |
| 363L00000X Nurse Practitioner (Licence: AP5002) | |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2020-10-08 |