Healthcare Provider Details

I. General information

NPI: 1083518062
Provider Name (Legal Business Name): MICHAEL GAINES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 E BELL RD STE 306
PHOENIX AZ
85032-2160
US

IV. Provider business mailing address

7528 N 19TH AVE UNIT 18
PHOENIX AZ
85021-7983
US

V. Phone/Fax

Practice location:
  • Phone: 602-923-5648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-32791
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: