| NPI | 1982067179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN A HALVORSON Owner 602-795-3649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 13423) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2017-02-17 |