Healthcare Provider Details

I. General information

NPI: 1457708034
Provider Name (Legal Business Name): CHANDLER PAIN MEDICINE & PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W QUEEN CREEK RD STE. #2
CHANDLER AZ
85248-8134
US

IV. Provider business mailing address

8351 E TAILFEATHER DR
SCOTTSDALE AZ
85255-6459
US

V. Phone/Fax

Practice location:
  • Phone: 480-814-1023
  • Fax: 480-814-7792
Mailing address:
  • Phone: 480-299-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0987
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number32912
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8894
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP7638
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP8549
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP4912
License Number StateAZ

VIII. Authorized Official

Name: DAVID VOYER
Title or Position: SOLE MEMBER
Credential:
Phone: 480-299-5700