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General NPI Number Information
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NPI Number | 1689749814
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Entity Type | Organization
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Legal Business Name | ROADRUNNER REHAB INCORPORATED
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 2290 W 16TH ST
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City | SAFFORD
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State | AZ
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Zip | 85546-4081
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Country | US
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Telephone | 928-348-4220
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Fax | 928-348-4234
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Provider Business Mailing Address
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Address Line | 2290 W 16TH ST
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City | SAFFORD
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State | AZ
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Zip | 85546-4081
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Country | US
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Telephone | 928-348-4220
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Fax | 928-348-4234
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARY E GUTIERREZ
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Credential |
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Telephone | 928-348-4220
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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 | 1841
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License Number State | AZ
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