Healthcare Provider Details

I. General information

NPI: 1780174888
Provider Name (Legal Business Name): NOVUM VALEBAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 10/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 S HIGLEY RD STE 103
GILBERT AZ
85296-4786
US

IV. Provider business mailing address

1485 S HIGLEY RD STE 103
GILBERT AZ
85296-4786
US

V. Phone/Fax

Practice location:
  • Phone: 480-237-3716
  • Fax: 480-658-2382
Mailing address:
  • Phone: 480-237-3716
  • Fax: 480-658-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HERRERA
Title or Position: OWNER
Credential:
Phone: 480-237-3716