Healthcare Provider Details

I. General information

NPI: 1447141924
Provider Name (Legal Business Name): DANCESOUL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E VAN BUREN ST
PHOENIX AZ
85006-4298
US

IV. Provider business mailing address

7725 S 37TH WAY
PHOENIX AZ
85042-9657
US

V. Phone/Fax

Practice location:
  • Phone: 602-487-2117
  • Fax:
Mailing address:
  • Phone: 602-487-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARA J WHITE
Title or Position: DIRECTOR
Credential:
Phone: 602-487-2117