Healthcare Provider Details

I. General information

NPI: 1821674086
Provider Name (Legal Business Name): INJURY DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE B301
PHOENIX AZ
85029-4618
US

IV. Provider business mailing address

3201 W PEORIA AVE STE B301
PHOENIX AZ
85029-4618
US

V. Phone/Fax

Practice location:
  • Phone: 480-542-5590
  • Fax: 480-542-5591
Mailing address:
  • Phone: 480-542-5590
  • Fax: 480-542-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW RHODES
Title or Position: MANAGING MEMBER
Credential: FNP-BC
Phone: 480-542-5590