Healthcare Provider Details

I. General information

NPI: 1962668764
Provider Name (Legal Business Name): ACTIVERX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10165 N 92ND ST STE 103
SCOTTSDALE AZ
85258-4558
US

IV. Provider business mailing address

3370 N HAYDEN RD # 123-505
SCOTTSDALE AZ
85251-6632
US

V. Phone/Fax

Practice location:
  • Phone: 480-304-5656
  • Fax: 480-704-4763
Mailing address:
  • Phone: 480-304-5510
  • Fax: 480-704-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5696
License Number StateAZ

VIII. Authorized Official

Name: MATT D ESSEX
Title or Position: PRESIDENT
Credential: MS
Phone: 602-741-6739