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General NPI Number Information
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NPI Number | 1558849596
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Entity Type | Organization
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Legal Business Name | NEUROFIT HEALTH PLLC
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 1200 N. BEAVER
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-779-1162
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Fax | 928-779-1163
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Provider Business Mailing Address
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Address Line | PO BOX 1150
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City | FLAGSTAFF
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State | AZ
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Zip | 86002-1150
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Country | US
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Telephone | 928-779-1162
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Fax | 928-779-1163
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MR. AARON PHILIP SHAW
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Credential | PA-C
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Telephone | 928-779-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 7036
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License Number State | AZ
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