Healthcare Provider Details

I. General information

NPI: 1306959218
Provider Name (Legal Business Name): CENTER FOR PHYSICAL MEDICINE & REHABILITATION P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 102
PHOENIX AZ
85020-4330
US

IV. Provider business mailing address

1331 N 7TH ST STE 360
PHOENIX AZ
85006-2772
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-7410
  • Fax: 602-246-7950
Mailing address:
  • Phone: 602-246-9002
  • Fax: 602-246-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN S LADIN
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 602-246-9002