Healthcare Provider Details

I. General information

NPI: 1407367139
Provider Name (Legal Business Name): SOUTHWEST PHYSIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E BELL RD STE 152
PHOENIX AZ
85032-9382
US

IV. Provider business mailing address

6807 N 14TH ST
PHOENIX AZ
85014-1133
US

V. Phone/Fax

Practice location:
  • Phone: 617-538-3650
  • Fax: 888-384-2827
Mailing address:
  • Phone: 617-538-3650
  • Fax: 888-384-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number44220
License Number State

VIII. Authorized Official

Name: DR. MICHAEL CRINCOLI
Title or Position: PRESIDENT
Credential: MD
Phone: 617-538-3650