Healthcare Provider Details

I. General information

NPI: 1013425792
Provider Name (Legal Business Name): ONE ACCORD PT SCOTTSDALE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 E HIGH ST STE 105
PHOENIX AZ
85054-5461
US

IV. Provider business mailing address

1377 E FLORENCE BLVD STE 151-L5
CASA GRANDE AZ
85122-5357
US

V. Phone/Fax

Practice location:
  • Phone: 602-821-8883
  • Fax: 602-821-8883
Mailing address:
  • Phone: 602-821-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name: LINA MARIA FLANNAGAN
Title or Position: MEMBER/MANAGER
Credential:
Phone: 602-617-5840