Healthcare Provider Details

I. General information

NPI: 1891315446
Provider Name (Legal Business Name): PREFERRED REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E WARNER RD STE B104
GILBERT AZ
85296-2972
US

IV. Provider business mailing address

235 E WARNER RD STE B104
GILBERT AZ
85296-2972
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-3151
  • Fax: 480-383-6076
Mailing address:
  • Phone: 480-633-3151
  • Fax: 480-383-6076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN GILLEN
Title or Position: MEMBER
Credential: DC
Phone: 480-633-3151