Healthcare Provider Details

I. General information

NPI: 1073705687
Provider Name (Legal Business Name): ADVANCED PHYSIOTHERAPY & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8129 N 35TH AVE #3
PHOENIX AZ
85051-5892
US

IV. Provider business mailing address

8129 N 35TH AVE #3
PHOENIX AZ
85051-5892
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-0000
  • Fax: 602-995-4444
Mailing address:
  • Phone: 602-242-0000
  • Fax: 602-995-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. SCOTT SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-242-0000