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NPI Code Detail

MEDICARE: WORK INJURY CENTER, LLC

MEDICARE: WORK INJURY CENTER, 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
1225100000XPhysical Therapist
2363LP2300XPrimary Care Nurse Practitioner

General Provider Information

NPI Number : 1881288702
Entity Type Code : Organization
Provider Name (Legal Business Name) : WORK INJURY CENTER, LLC
Provider Business Mailing Address
First Line : 3201 W PEORIA AVE STE B301
Second Line :
City : PHOENIX
State : AZ
Zip : 85029-4618
Country : US
Telephone Number : 602-767-7788
Fax Number : 602-610-6981
Provider Business Practice Location Address
First Line : 3201 W PEORIA AVE STE B301
Second Line :
City : PHOENIX
State : AZ
Zip : 85029-4618
Country : US
Telephone Number : 602-767-7788
Fax Number : 602-610-6981
Authorized Official
Title or Position : CEO
Name : MIKE DAVIS
Credential :
Telephone Number : 323-219-8124
Provider Enumeration Date : 02/22/2021
Last Update Date : 02/22/2021

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