Healthcare Provider Details

I. General information

NPI: 1164565768
Provider Name (Legal Business Name): OPTIMED FITNESS MEDICAL REHAB & WEIGHT LOSS CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13206 N 7TH ST
PHOENIX AZ
85022-5394
US

IV. Provider business mailing address

13206 N 7TH ST
PHOENIX AZ
85022-5394
US

V. Phone/Fax

Practice location:
  • Phone: 602-866-3454
  • Fax: 602-866-3454
Mailing address:
  • Phone: 602-866-3454
  • Fax: 602-866-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008
License Number StateAZ

VIII. Authorized Official

Name: DR. JEFFREY ALAN LOWY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 602-866-0677