Healthcare Provider Details

I. General information

NPI: 1194708479
Provider Name (Legal Business Name): DAVID A GROSSBLAT M.D., P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

300 W CLARENDON AVE SUITE 142
PHOENIX AZ
85013-3420
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3000
  • Fax:
Mailing address:
  • Phone: 602-234-1803
  • Fax: 602-234-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number44436
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5561
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: