Healthcare Provider Details

I. General information

NPI: 1164980389
Provider Name (Legal Business Name): PRECISION PHYSICAL THERAPY AND SPORTS MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E SOUTHERN AVE
TEMPE AZ
85282-5214
US

IV. Provider business mailing address

422 E SOUTHERN AVE
TEMPE AZ
85282-5214
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-9399
  • Fax:
Mailing address:
  • Phone: 480-497-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY A RAIFFIE
Title or Position: OWNER
Credential: DC
Phone: 602-692-2110