Healthcare Provider Details

I. General information

NPI: 1942291117
Provider Name (Legal Business Name): MOHAVE NEURO REHAB CONSUL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 E HAMMER LN STE 106
FORT MOHAVE AZ
86426-6664
US

IV. Provider business mailing address

1520 E HAMMER LN STE 106
FORT MOHAVE AZ
86426-6664
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-6600
  • Fax: 928-681-6606
Mailing address:
  • Phone: 928-681-6600
  • Fax: 928-681-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS J. PARKS
Title or Position: OWNER
Credential: MD
Phone: 928-681-6600