Healthcare Provider Details

I. General information

NPI: 1396383402
Provider Name (Legal Business Name): AZ REHAB CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W CHANDLER BLVD
CHANDLER AZ
85224-6141
US

IV. Provider business mailing address

16772 W BELL RD STE 110-619
SURPRISE AZ
85374-9702
US

V. Phone/Fax

Practice location:
  • Phone: 602-844-4855
  • Fax:
Mailing address:
  • Phone: 602-844-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier59615
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerAZ LICENSE

VIII. Authorized Official

Name: JOSEPH WONG
Title or Position: OWNER
Credential:
Phone: 216-390-1402