MEDICARE: VALLEY VIEW PHYSICIAN PRACTICES, 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	208100000X	Physical Medicine & Rehabilitation Physician
2	208100000X	Physical Medicine & Rehabilitation Physician	33446	AZ

General Provider Information

NPI Number	:	1780009621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VIEW PHYSICIAN PRACTICES, LLC

Provider Business Mailing Address
First Line	:	5300 S. HIGHWAY 95
Second Line	:	STE. D
City	:	FT. MOHAVE
State	:	AZ
Zip	:	86426
Country	:	US
Telephone Number	:	928-788-3609
Fax Number	:	928-788-3607

Provider Business Practice Location Address
First Line	:	5300 S. HIGHWAY 95
Second Line	:	STE. D.
City	:	FT. MOHAVE
State	:	AZ
Zip	:	86426
Country	:	US
Telephone Number	:	928-788-3609
Fax Number	:	928-788-3607

Authorized Official
Title or Position	:	SECRETARY
Name	:	CHARLOTTE LAWRENCE
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	03/02/2014
Last Update Date	:	01/12/2025

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