Healthcare Provider Details

I. General information

NPI: 1114920642
Provider Name (Legal Business Name): VINCENT DALE KAME P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 E LINCOLN DR STE A101
SCOTTSDALE AZ
85253-4433
US

IV. Provider business mailing address

7100 E LINCOLN DR STE A101
SCOTTSDALE AZ
85253-4433
US

V. Phone/Fax

Practice location:
  • Phone: 480-609-0822
  • Fax: 480-609-0828
Mailing address:
  • Phone: 480-609-0822
  • Fax: 480-609-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2252
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: