Healthcare Provider Details

I. General information

NPI: 1093353427
Provider Name (Legal Business Name): MEDI-SSAGE HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 04/30/2024
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N 18TH ST STE 301
PHOENIX AZ
85006-3759
US

IV. Provider business mailing address

1480 E PECOS RD APT 2038
GILBERT AZ
85295-1838
US

V. Phone/Fax

Practice location:
  • Phone: 480-770-4606
  • Fax: 480-546-5199
Mailing address:
  • Phone: 480-479-5003
  • Fax: 480-546-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARRICKA WATKINS
Title or Position: ED & FOUNDER
Credential: LMT,MMP,PSS
Phone: 480-770-4606