Healthcare Provider Details

I. General information

NPI: 1609662709
Provider Name (Legal Business Name): MODERN SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E BROADWAY BLVD STE 132
TUCSON AZ
85716-5348
US

IV. Provider business mailing address

5590 W CHANDLER BLVD STE 4
CHANDLER AZ
85226-3744
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-6627
  • Fax: 480-306-6696
Mailing address:
  • Phone: 480-306-6627
  • Fax: 480-306-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA ADAMS
Title or Position: OWNER
Credential:
Phone: 480-306-6627