Healthcare Provider Details

I. General information

NPI: 1437416146
Provider Name (Legal Business Name): PRO SPORTS PERFORMANCE & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 E VIA DE VENTURA SUITE #101
SCOTTSDALE AZ
85258-3326
US

IV. Provider business mailing address

8630 E VIA DE VENTURA SUITE #101
SCOTTSDALE AZ
85258-3326
US

V. Phone/Fax

Practice location:
  • Phone: 480-433-4760
  • Fax:
Mailing address:
  • Phone: 480-433-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number7369
License Number StateAZ

VIII. Authorized Official

Name: TROY K MEINERS
Title or Position: CLINIC DIRECTOR
Credential: PT
Phone: 480-433-4760