Healthcare Provider Details

I. General information

NPI: 1265849327
Provider Name (Legal Business Name): APRIL CANNON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6279
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6279
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-4961
  • Fax: 480-860-0356
Mailing address:
  • Phone: 480-551-4961
  • Fax: 480-860-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10949A
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: