Healthcare Provider Details

I. General information

NPI: 1811399017
Provider Name (Legal Business Name): HEALING EDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 N LITCHFIELD RD STE 120
GOODYEAR AZ
85395-7803
US

IV. Provider business mailing address

3030 N LITCHFIELD RD STE 120
GOODYEAR AZ
85395-7803
US

V. Phone/Fax

Practice location:
  • Phone: 623-777-4555
  • Fax: 623-242-5755
Mailing address:
  • Phone: 623-777-4555
  • Fax: 623-242-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number270
License Number StateAZ

VIII. Authorized Official

Name: TONI BENNALLEY
Title or Position: OWNER
Credential:
Phone: 623-777-4555