Healthcare Provider Details

I. General information

NPI: 1073515235
Provider Name (Legal Business Name): NORTHERN ARIZONA REHABILITATION & FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S WILLARD ST STE 106
COTTONWOOD AZ
86326-6744
US

IV. Provider business mailing address

450 S WILLARD ST STE 106
COTTONWOOD AZ
86326-6744
US

V. Phone/Fax

Practice location:
  • Phone: 928-649-9726
  • Fax: 928-634-2079
Mailing address:
  • Phone: 928-649-9726
  • Fax: 928-634-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13044799E
License Number StateAZ

VIII. Authorized Official

Name: MRS. CINDY MARIE MESA
Title or Position: RECEPTIONIST
Credential:
Phone: 928-649-9726