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NPI Code Detail

MEDICARE: MR. JOHN EDWARD EBINGER

MEDICARE: MR. JOHN EDWARD EBINGER
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
1225100000XPhysical Therapist034474NY
22251S0007XSports Physical TherapistLPT-31803AZ

General Provider Information

NPI Number : 1245586817
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN EDWARD EBINGER
Provider Business Mailing Address
First Line : 2006 E ANDERSON DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85022-2254
Country : US
Telephone Number : 631-455-7146
Fax Number :
Provider Business Practice Location Address
First Line : 1729 W GREENTREE DR STE 101
Second Line :
City : TEMPE
State : AZ
Zip : 85284-2712
Country : US
Telephone Number : 480-785-1765
Fax Number : 480-785-4533
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2012
Last Update Date : 12/28/2021

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