Healthcare Provider Details

I. General information

NPI: 1386338622
Provider Name (Legal Business Name): MELISSA MARKIE BACHTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 N ESTRELLA PKWY STE A1
GOODYEAR AZ
85338-2885
US

IV. Provider business mailing address

4015 S 44TH ST
PHOENIX AZ
85040-2058
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-0654
  • Fax:
Mailing address:
  • Phone: 520-255-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTA-013932
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: