Healthcare Provider Details

I. General information

NPI: 1700033412
Provider Name (Legal Business Name): 60002 AVONDALE REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12409 W INDIAN SCHOOL RD B210
AVONDALE AZ
85392-9502
US

IV. Provider business mailing address

PO BOX 2954
PHOENIX AZ
85082-2954
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9920
  • Fax:
Mailing address:
  • Phone: 623-935-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7536
License Number StateAZ

VIII. Authorized Official

Name: DR. KRISTA MARIE GERAU
Title or Position: OWNER
Credential: DC
Phone: 623-935-9920