Healthcare Provider Details

I. General information

NPI: 1609635564
Provider Name (Legal Business Name): STEVEN JAMES SEIBEL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 E GREENWAY RD STE 1
PHOENIX AZ
85032-4798
US

IV. Provider business mailing address

24828 N 39TH AVE
GLENDALE AZ
85310-3313
US

V. Phone/Fax

Practice location:
  • Phone: 602-932-3477
  • Fax:
Mailing address:
  • Phone: 602-920-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number010956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: