Healthcare Provider Details

I. General information

NPI: 1548505175
Provider Name (Legal Business Name): MANI MURUGESAN PT, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MANIKANDAN MURUGESAN PT

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 N 2ND ST STE 601
PHOENIX AZ
85012-2395
US

IV. Provider business mailing address

4600 S MILL AVE #280
TEMPE AZ
85282-6850
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax:
Mailing address:
  • Phone: 480-305-2888
  • Fax: 480-305-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6218
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA6218
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10679
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012971
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: