Healthcare Provider Details

I. General information

NPI: 1316311319
Provider Name (Legal Business Name): BODY MECHANICS MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 E HIGH ST STE 107
PHOENIX AZ
85054-5456
US

IV. Provider business mailing address

4127 E PULLMAN RD
CAVE CREEK AZ
85331-4007
US

V. Phone/Fax

Practice location:
  • Phone: 480-282-8485
  • Fax:
Mailing address:
  • Phone: 480-292-1734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAP7566
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10198
License Number StateAZ

VIII. Authorized Official

Name: DR. STACEY DEWOLF
Title or Position: OWNER, CEO
Credential:
Phone: 480-282-8485