Healthcare Provider Details

I. General information

NPI: 1396986956
Provider Name (Legal Business Name): BARBARA L SLEGEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N PLAZA DR
APACHE JUNCTION AZ
85220-5505
US

IV. Provider business mailing address

305 N PLAZA DR
APACHE JUNCTION AZ
85220-5505
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-7794
  • Fax: 480-982-0747
Mailing address:
  • Phone: 480-982-7794
  • Fax: 480-982-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0182A
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: