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General NPI Number Information
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NPI Number | 1376588715
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Entity Type | Organization
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Legal Business Name | THE REJUVENATION CENTER OF CHANDLER
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 1445 W CHANDLER BLVD BLDG A
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City | CHANDLER
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State | AZ
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Zip | 85224-6130
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Country | US
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Telephone | 480-899-4878
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 S 72ND ST STE 302
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City | OMAHA
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State | NE
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Zip | 68124-1734
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Country | US
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Telephone | 402-391-2635
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Fax | 402-391-0326
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Authorized Official
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Title or Position | BILLING OPERATIONS MANAGER
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Name | MS. SHANNON L SMITH
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Credential |
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Telephone | 402-391-2635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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