Healthcare Provider Details

I. General information

NPI: 1265682850
Provider Name (Legal Business Name): ARIZONA PHYSICAL MEDICINE AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 12/01/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5690 W CHANDLER BLVD STE 2
CHANDLER AZ
85226-3356
US

IV. Provider business mailing address

PO BOX 36
TEMPE AZ
85280-0036
US

V. Phone/Fax

Practice location:
  • Phone: 480-878-7425
  • Fax: 480-207-1025
Mailing address:
  • Phone: 480-878-7425
  • Fax: 480-207-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number40368
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40368
License Number StateAZ

VIII. Authorized Official

Name: DR. MOHAMMAD IQBAL UDDIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-878-7425