Healthcare Provider Details

I. General information

NPI: 1700115151
Provider Name (Legal Business Name): RALPH ANTHONY NEIGHBORS MS, ATC/L, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TONY NEIGHBORS MS, ATC/L, CSCS

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 N 88TH ST
MESA AZ
85207-5107
US

IV. Provider business mailing address

1138 N 88TH ST
MESA AZ
85207-5107
US

V. Phone/Fax

Practice location:
  • Phone: 602-369-1194
  • Fax:
Mailing address:
  • Phone: 602-369-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0158
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: