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General NPI Number Information
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NPI Number | 1437483591
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Entity Type | Organization
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Legal Business Name | SPORTS CONDITIONING CLINIC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 2394 E CAMELBACK RD STE 120
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City | PHOENIX
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State | AZ
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Zip | 85016-3429
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Country | US
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Telephone | 602-224-5724
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Fax |
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Provider Business Mailing Address
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Address Line | 2394 E CAMELBACK RD STE 120
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City | PHOENIX
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State | AZ
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Zip | 85016-3429
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Country | US
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Telephone | 602-224-5724
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. VINCENT JAMES BOCCHICCHIO
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Credential | PH D
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Telephone | 602-224-5724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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