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General NPI Number Information
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NPI Number | 1720875172
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Entity Type | Organization
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Legal Business Name | GREENWAY BACKFIT MEDICAL VENTURE LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 2302 W GREENWAY RD
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City | PHOENIX
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State | AZ
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Zip | 85023-4235
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Country | US
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Telephone | 877-222-5348
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6610
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City | CHANDLER
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State | AZ
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Zip | 85246-6610
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | SENA FORD
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Credential |
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Telephone | 480-926-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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