Healthcare Provider Details

I. General information

NPI: 1801975917
Provider Name (Legal Business Name): JOSEPH PAUL AUDITORE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N 98TH ST
MESA AZ
85207-8902
US

IV. Provider business mailing address

121 N 98TH ST
MESA AZ
85207-8902
US

V. Phone/Fax

Practice location:
  • Phone: 480-357-7181
  • Fax: 480-357-9767
Mailing address:
  • Phone: 480-357-7181
  • Fax: 480-357-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-02453P
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: