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General NPI Number Information
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NPI Number | 1649909979
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Entity Type | Organization
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Legal Business Name | CAMOU HOLDINGS
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 13128 N 94TH DRIVE SUITE 207
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City | PEORIA
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State | AZ
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Zip | 85381-4253
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Country | US
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Telephone | 623-974-1797
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Fax | 623-974-1796
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Provider Business Mailing Address
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Address Line | 13128 N 94TH DRIVE SUITE 207
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City | PEORIA
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State | AZ
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Zip | 85381-4253
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Country | US
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Telephone | 623-337-2125
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TANIA CAMOU
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Credential | PHYSICAL THERAPIST
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Telephone | 623-337-2125
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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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