Healthcare Provider Details

I. General information

NPI: 1053012393
Provider Name (Legal Business Name): ASAP PT AND CHIRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W GREENWAY RD STE 300
PHOENIX AZ
85023-4292
US

IV. Provider business mailing address

2525 W GREENWAY RD STE 300
PHOENIX AZ
85023-4292
US

V. Phone/Fax

Practice location:
  • Phone: 480-573-0130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JARRETT LEATHEM
Title or Position: OWNER MD
Credential:
Phone: 480-573-0130