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General NPI Number Information
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NPI Number | 1104763051
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Entity Type | Organization
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Legal Business Name | PK NEUROLOGY PLLC
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 455 N MESA DR STE 5
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City | MESA
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State | AZ
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Zip | 85201-5936
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Country | US
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Telephone | 480-813-2906
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Fax |
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Provider Business Mailing Address
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Address Line | 5738 E STAR VALLEY ST
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City | MESA
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State | AZ
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Zip | 85215-9664
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Country | US
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Telephone | 801-471-7340
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. PAUL LANIER
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Credential | DO
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Telephone | 801-471-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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