MEDICARE: SONORAN THERAPY GROUP INC.

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	251S00000X	Community/Behavioral Health Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1841486651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORAN THERAPY GROUP INC.

Provider Business Mailing Address
First Line	:	3655 W ANTHEM WAY
Second Line	:	SUITE A-109, PMB 213
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3655 W ANTHEM WAY
Second Line	:	SUITE A-109, PMB 213
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0430
Country	:	US
Telephone Number	:	602-999-0161
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY / OWNER
Name	:	CHAD SLAYBAUGH
Credential	:
Telephone Number	:	602-999-0161

Provider Enumeration Date	:	09/15/2007
Last Update Date	:	09/15/2007

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