MEDICARE: CONTINUUM WELLNESS CLINIC, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	8062	AZ

General Provider Information

NPI Number	:	1144583592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTINUUM WELLNESS CLINIC, LLC

Provider Business Mailing Address
First Line	:	3941 E BASELINE RD
Second Line	:	SUITE 101
City	:	GILBERT
State	:	AZ
Zip	:	85234-2750
Country	:	US
Telephone Number	:	480-503-2010
Fax Number	:	480-503-2300

Provider Business Practice Location Address
First Line	:	1075 S IDAHO RD
Second Line	:	SUITE 210
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85119-6496
Country	:	US
Telephone Number	:	480-983-0877
Fax Number	:	480-983-3172

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	STEVE DAVIDSON
Credential	:	P.T.
Telephone Number	:	616-356-5000

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	01/17/2013

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