Healthcare Provider Details

I. General information

NPI: 1003230301
Provider Name (Legal Business Name): CONTINUUM GROUP WEST, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 W GREENWAY RD SUITE 104
PHOENIX AZ
85053
US

IV. Provider business mailing address

3710 W. GREENWAY RD. SUITE 104
PHOENIX AZ
85053
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-0231
  • Fax: 602-993-5648
Mailing address:
  • Phone: 602-993-0231
  • Fax: 602-993-5648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4858
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number32912
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6029
License Number StateAZ

VIII. Authorized Official

Name: MR. SCOTT HERRON
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-993-0231