=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376638452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARIZONA INDUSTRIAL, SPORT & SPINE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26439 S TANGELO AVE STE 1
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-8038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-897-9016
-----------------------------------------------------
Fax | 480-718-8494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26439 S TANGELO AVE STE 1
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-8038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-897-9016
-----------------------------------------------------
Fax | 480-718-8494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ CORPORATE PRESIDENT
-----------------------------------------------------
Name | MR. ALLEN T. ADAMS
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 480-897-9016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 2113
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------