MEDICARE: FOOTHILLS SPORTS MEDICINE & REHABILITATION, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251S0007X	Sports Physical Therapist
2	2251X0800X	Orthopedic Physical Therapist
3	261QP2000X	Physical Therapy Clinic/Center
4	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1699405050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILLS SPORTS MEDICINE & REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	15410 S MOUNTAIN PKWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-6691
Country	:	US
Telephone Number	:	480-940-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 N SWAN RD STE 115
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1273
Country	:	US
Telephone Number	:	520-744-6445
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE MANAGEMENT
Name	:	SARAH BINDER
Credential	:
Telephone Number	:	480-410-4727

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	10/26/2023

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