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General NPI Number Information
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NPI Number | 1578570081
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Entity Type | Individual
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Provider Name | SERGIO I MACIAS PT
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 1233 N MAIN STREET SUITE 10, 11 & 12
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City | SAN LUIS
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State | AZ
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Zip | 85349-9999
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Country | US
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Telephone | 928-722-6050
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Fax | 928-722-6094
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Provider Business Mailing Address
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Address Line | PO BOX 5841
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City | YUMA
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State | AZ
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Zip | 85366-2490
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Country | US
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Telephone | 928-343-7911
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Fax | 928-343-9528
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4229
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | C001071
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License Number State | AZ
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