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General NPI Number Information
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NPI Number | 1548702111
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Entity Type | Organization
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Legal Business Name | BLUE SKYES WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/13/2016
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Last Update Date | 11/13/2016
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Provider Practice Location Address
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Address Line | 625 N GILBERT RD SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85234-3398
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Country | US
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Telephone | 602-845-9748
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Fax |
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Provider Business Mailing Address
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Address Line | 625 N GILBERT RD SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85234-3398
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Country | US
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Telephone | 602-845-9748
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DAVONNA MARIE WILLIS
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Credential | ATC, LMT
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Telephone | 602-845-9748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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