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General NPI Number Information
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NPI Number | 1386871440
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Entity Type | Individual
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Provider Name | KADEEN MANSOR PT
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Gender | Male
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 6345 S CEDAR SPRINGS ST
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City | CAMP VERDE
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State | AZ
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Zip | 86322
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Country | US
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Telephone | 602-793-1215
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 943
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City | CAMP VERDE
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State | AZ
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Zip | 86322-0943
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Country | US
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Telephone | 602-793-1215
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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 | 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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