Healthcare Provider Details

I. General information

NPI: 1699832808
Provider Name (Legal Business Name): JANELLE MARIE HOWARD P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 W DEER VALLEY RD SUITE 100
PEORIA AZ
85382-2101
US

IV. Provider business mailing address

1317 W VERMONT AVE
PHOENIX AZ
85013-1959
US

V. Phone/Fax

Practice location:
  • Phone: 623-376-9100
  • Fax:
Mailing address:
  • Phone: 602-328-9327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0277A
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: