Healthcare Provider Details

I. General information

NPI: 1407467962
Provider Name (Legal Business Name): GILBERT RECKER 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 E. WILLIAMS FIELD RD SUITE 101
GILBERT AZ
85295
US

IV. Provider business mailing address

4049 E WILLIAMS FIELD RD. SUITE 101
GILBERT AZ
85295
US

V. Phone/Fax

Practice location:
  • Phone: 480-597-9497
  • Fax: 480-597-9484
Mailing address:
  • Phone: 480-597-9497
  • Fax: 480-597-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANDRIA TAYLOR
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-597-9497