Healthcare Provider Details

I. General information

NPI: 1659645679
Provider Name (Legal Business Name): AFC PHYSICAL MEDICINE OF MESA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 E BASELINE RD SUITE 107
MESA AZ
85204-7290
US

IV. Provider business mailing address

1839 S ALMA SCHOOL RD STE 354
MESA AZ
85210-3028
US

V. Phone/Fax

Practice location:
  • Phone: 480-345-1980
  • Fax: 480-926-1721
Mailing address:
  • Phone: 480-726-2287
  • Fax: 888-316-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7046960001
License Number StateAZ

VIII. Authorized Official

Name: JOSHUA F. BOCK
Title or Position: MANAGING MEMBER
Credential:
Phone: 480-726-2287