Healthcare Provider Details

I. General information

NPI: 1699405050
Provider Name (Legal Business Name): FOOTHILLS SPORTS MEDICINE & REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 N SWAN RD STE 115
TUCSON AZ
85712-1273
US

IV. Provider business mailing address

15410 S MOUNTAIN PKWY
PHOENIX AZ
85044-6691
US

V. Phone/Fax

Practice location:
  • Phone: 520-744-6445
  • Fax:
Mailing address:
  • Phone: 480-940-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH BINDER
Title or Position: DIRECTOR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 480-410-4727