Healthcare Provider Details

I. General information

NPI: 1518160183
Provider Name (Legal Business Name): FOOTHILLS SPORTS MEDICINE AND REHABILITATION BILTMORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE SUITE 200
PHOENIX AZ
85016-4872
US

IV. Provider business mailing address

2222 E HIGHLAND AVE SUITE 200
PHOENIX AZ
85016-4872
US

V. Phone/Fax

Practice location:
  • Phone: 602-595-6180
  • Fax: 602-595-7659
Mailing address:
  • Phone: 602-595-6180
  • Fax: 602-595-7659

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