Healthcare Provider Details

I. General information

NPI: 1710614128
Provider Name (Legal Business Name): PREFERRED VERVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 E QUEEN CREEK RD STE 109
GILBERT AZ
85297-8510
US

IV. Provider business mailing address

4838 E BASELINE RD STE 110
MESA AZ
85206-4674
US

V. Phone/Fax

Practice location:
  • Phone: 480-582-3210
  • Fax: 480-436-6571
Mailing address:
  • Phone: 480-582-3210
  • Fax: 480-436-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BETHANY S WRIGHT
Title or Position: AUTHORIZED CONTACT
Credential:
Phone: 310-770-6368