Healthcare Provider Details

I. General information

NPI: 1386691947
Provider Name (Legal Business Name): FOOTHILLS SPORTS MEDICINE & REHABILITATION- TATUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E BELL RD SUITE 270
PHOENIX AZ
85032-9306
US

IV. Provider business mailing address

4550 E BELL RD SUITE 270
PHOENIX AZ
85032-9306
US

V. Phone/Fax

Practice location:
  • Phone: 602-923-6600
  • Fax: 602-923-6611
Mailing address:
  • Phone: 602-923-6600
  • Fax: 602-923-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TANJA SNOWDEN
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 480-706-1161