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General NPI Number Information
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NPI Number | 1245800267
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Entity Type | Individual
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Provider Name | BUNJA TRAWALLY
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Gender | Male
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 23005 N 74TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-7500
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Country | US
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Telephone | 888-842-3780
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Fax |
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Provider Business Mailing Address
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Address Line | 16825 N 14TH ST UNIT 79
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City | PHOENIX
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State | AZ
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Zip | 85022-7739
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Country | US
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Telephone | 602-770-9999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA-014181
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License Number State | AZ
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