MEDICARE: ARIZONA SPORTS MEDICINE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1114623246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA SPORTS MEDICINE PLLC

Provider Business Mailing Address
First Line	:	2034 E SOUTHERN AVE STE K
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7511
Country	:	US
Telephone Number	:	480-400-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	2034 E SOUTHERN AVE STE K
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7511
Country	:	US
Telephone Number	:	480-400-6225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PHILLIP VEATCH
Credential	:	PA-C
Telephone Number	:	480-438-0069

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	03/16/2026

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