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General NPI Number Information
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NPI Number | 1073802542
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Entity Type | Organization
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Legal Business Name | SPRINGBOK WELLNESS AND REHAB L.L.C.
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 1400 N GILBERT RD SUITE M
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City | GILBERT
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State | AZ
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Zip | 85234-2328
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Country | US
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Telephone | 480-558-0474
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Fax | 480-558-0478
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Provider Business Mailing Address
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Address Line | 1400 N GILBERT RD SUITE M
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City | GILBERT
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State | AZ
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Zip | 85234-2328
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Country | US
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Telephone | 480-558-0474
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Fax | 480-558-0478
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CLIFFORD BRENDON GIBB
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Credential |
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Telephone | 480-558-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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