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General NPI Number Information
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NPI Number | 1578853065
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Entity Type | Organization
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Legal Business Name | BASELINE DISTRIBUTING, LLC
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 920 E HARWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85042-6605
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Country | US
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Telephone | 602-908-2667
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Fax |
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Provider Business Mailing Address
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Address Line | 920 E HARWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85042-6605
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Country | US
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Telephone | 602-908-2667
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RYAN DEAN PALMER
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Credential |
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Telephone | 602-908-2667
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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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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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