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General NPI Number Information
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NPI Number | 1407367139
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PHYSIATRY PLLC
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 4550 E BELL RD STE 152
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City | PHOENIX
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State | AZ
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Zip | 85032-9382
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Country | US
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Telephone | 617-538-3650
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Fax | 888-384-2827
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Provider Business Mailing Address
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Address Line | 6807 N 14TH ST
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City | PHOENIX
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State | AZ
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Zip | 85014-1133
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Country | US
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Telephone | 617-538-3650
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Fax | 888-384-2827
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL CRINCOLI
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Credential | MD
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Telephone | 617-538-3650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 44220
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License Number State |
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