Healthcare Provider Details

I. General information

NPI: 1336879873
Provider Name (Legal Business Name): ARIZONA LYMPHEDEMA INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

8771 N HUCKELBERRY WAY
TUCSON AZ
85742-4179
US

IV. Provider business mailing address

8771 N HUCKELBERRY WAY
TUCSON AZ
85742-4179
US

V. Phone/Fax

Practice location:
  • Phone: 760-406-2681
  • Fax:
Mailing address:
  • Phone: 760-406-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK D SCHMIDT
Title or Position: CEO AND OWNER
Credential:
Phone: 760-406-2681