Healthcare Provider Details

I. General information

NPI: 1255562625
Provider Name (Legal Business Name): CARL M BISCONTINI PT,DPT,CSCS,CGFI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 11/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 S SAWMILL RD
GILBERT AZ
85297-3079
US

IV. Provider business mailing address

4108 S SAWMILL RD
GILBERT AZ
85297-3079
US

V. Phone/Fax

Practice location:
  • Phone: 623-282-4009
  • Fax:
Mailing address:
  • Phone: 623-282-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number8565
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8565
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: