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General NPI Number Information
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NPI Number | 1700785771
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Entity Type | Organization
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Legal Business Name | MODERN SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 9150 W INDIAN SCHOOL RD STE 117
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City | PHOENIX
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State | AZ
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Zip | 85037-2387
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Country | US
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Telephone | 480-306-6627
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Fax | 480-306-6696
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Provider Business Mailing Address
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Address Line | 5590 W CHANDLER BLVD STE 4
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City | CHANDLER
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State | AZ
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Zip | 85226-3744
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Country | US
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Telephone | 480-306-6627
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Fax | 480-306-6696
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | SASHA FLYNN
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Credential |
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Telephone | 480-232-0180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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