Healthcare Provider Details

I. General information

NPI: 1235227364
Provider Name (Legal Business Name): JOHN SCOTT METTHAM D.C., P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 S 40TH ST STE 129
PHOENIX AZ
85048-0560
US

IV. Provider business mailing address

16515 S 40TH ST STE 129
PHOENIX AZ
85048-0560
US

V. Phone/Fax

Practice location:
  • Phone: 480-940-7444
  • Fax: 480-940-7454
Mailing address:
  • Phone: 480-940-7444
  • Fax: 480-940-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7077
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: