Healthcare Provider Details

I. General information

NPI: 1174988364
Provider Name (Legal Business Name): SWSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9913 N 95TH ST
SCOTTSDALE AZ
85258-4586
US

IV. Provider business mailing address

9913 N 95TH ST
SCOTTSDALE AZ
85258-4586
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-8998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W WOLFF
Title or Position: MEMBER
Credential: MD
Phone: 480-860-8998