Healthcare Provider Details

I. General information

NPI: 1568909562
Provider Name (Legal Business Name): T&D HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30099 N 129TH DR
PEORIA AZ
85383-5267
US

IV. Provider business mailing address

30099 N 129TH DR
PEORIA AZ
85383-5267
US

V. Phone/Fax

Practice location:
  • Phone: 928-501-6666
  • Fax:
Mailing address:
  • Phone: 623-680-6547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00023598
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD00023598
License Number StateWA

VIII. Authorized Official

Name: THEODORE MANOS
Title or Position: PRESIDENT
Credential: MD
Phone: 623-680-6547