Healthcare Provider Details

I. General information

NPI: 1477318012
Provider Name (Legal Business Name): GIARDINA SPORTSMEDICINE CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 05/02/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E BELL RD STE 58
PHOENIX AZ
85022-6318
US

IV. Provider business mailing address

PO BOX 71846
PHOENIX AZ
85050-1015
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-8486
  • Fax: 602-843-8488
Mailing address:
  • Phone: 480-272-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DREW GIARDINA
Title or Position: OWNER
Credential:
Phone: 602-499-1139