Healthcare Provider Details

I. General information

NPI: 1376714253
Provider Name (Legal Business Name): HEALTH CENTERS OF ARIZONA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E. WARNER RD B-104
GILBERT AZ
85296-2972
US

IV. Provider business mailing address

235 E. WARNER RD B-104
GILBERT AZ
85296-2972
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-3540
  • Fax: 480-633-5605
Mailing address:
  • Phone: 480-633-3540
  • Fax: 480-633-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6795
License Number StateAZ

VIII. Authorized Official

Name: BRANDON ROBERT CARROLL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 480-633-3540