Healthcare Provider Details

I. General information

NPI: 1285676569
Provider Name (Legal Business Name): SAIJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10325 E RIGGS RD #102
SUN LAKES AZ
85248-7623
US

IV. Provider business mailing address

10325 E RIGGS RD #102
SUN LAKES AZ
85248-7623
US

V. Phone/Fax

Practice location:
  • Phone: 480-802-7081
  • Fax: 480-802-9492
Mailing address:
  • Phone: 480-802-7081
  • Fax: 480-802-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberOTC3123
License Number StateAZ

VIII. Authorized Official

Name: MRS. KIMBERLY DURKA
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-802-7081