Healthcare Provider Details

I. General information

NPI: 1598945768
Provider Name (Legal Business Name): CONCENTRA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E SKY HARBOR CIR N
PHOENIX AZ
85034-3407
US

IV. Provider business mailing address

1818 E SKY HARBOR CIR N
PHOENIX AZ
85034-3407
US

V. Phone/Fax

Practice location:
  • Phone: 602-244-9500
  • Fax: 602-914-9159
Mailing address:
  • Phone: 602-244-9500
  • Fax: 602-914-9159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberD05865502
License Number StateAZ

VIII. Authorized Official

Name: MS. DEVIN MARIE NOVAK
Title or Position: PHYSICAL THERAPIST
Credential: P.T
Phone: 602-244-9500