Healthcare Provider Details

I. General information

NPI: 1326818394
Provider Name (Legal Business Name): JIHAN THOMAS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF ROUTES N12 AND N7
FORT DEFIANCE AZ
86504-0649
US

IV. Provider business mailing address

3451 S MERCY RD STE 102
GILBERT AZ
85297-0206
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number170428
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: