Healthcare Provider Details

I. General information

NPI: 1578072419
Provider Name (Legal Business Name): NORTH SCOTTSDALE OUTPATIENT TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 E DESERT COVE AVE #103
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

8952 E DESERT COVE AVE STE 103
SCOTTSDALE AZ
85260-6776
US

V. Phone/Fax

Practice location:
  • Phone: 480-657-9202
  • Fax: 480-657-9341
Mailing address:
  • Phone: 480-657-9202
  • Fax: 480-657-9341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET HEALEY
Title or Position: PARTNER
Credential:
Phone: 480-657-9202