MEDICARE: SOUTHWEST THERAPY SPECIALISTS, P.C.

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	2251H1200X	Hand Physical Therapist
2	225XH1200X	Hand Occupational Therapist	0382	AZ
3	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1871647289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST THERAPY SPECIALISTS, P.C.

Provider Business Mailing Address
First Line	:	7540 N 19TH AVE
Second Line	:	STE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7967
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:	602-249-4115

Provider Business Practice Location Address
First Line	:	7540 N 19TH AVE
Second Line	:	STE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7967
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:	602-249-4115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SUSAN M STOCKDELL
Credential	:	O.T.R.L,C.H.T.
Telephone Number	:	602-249-9129

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/19/2012

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