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General NPI Number Information
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NPI Number | 1568909562
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Entity Type | Organization
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Legal Business Name | T&D HEALTH LLC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 30099 N 129TH DR
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City | PEORIA
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State | AZ
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Zip | 85383-5267
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Country | US
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Telephone | 928-501-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 30099 N 129TH DR
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City | PEORIA
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State | AZ
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Zip | 85383-5267
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Country | US
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Telephone | 623-680-6547
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE MANOS
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Credential | MD
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Telephone | 623-680-6547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD00023598
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD00023598
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License Number State | WA
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