Healthcare Provider Details

I. General information

NPI: 1609581123
Provider Name (Legal Business Name): AURELIO PERFORMANCE PHYSICAL THERAPY OF SCOTTSDALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 E MCDOWELL RD STE 113
SCOTTSDALE AZ
85257-3868
US

IV. Provider business mailing address

12627 E CENTRAL AVE STE 308
WICHITA KS
67206-2839
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-3311
  • Fax:
Mailing address:
  • Phone: 316-260-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOGAN MADDING
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 316-260-3311