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General NPI Number Information
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NPI Number | 1740529536
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE OF ARIZONA, LLC
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 2181 E PECOS RD SUITE 1
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City | CHANDLER
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State | AZ
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Zip | 85225-6140
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Country | US
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Telephone | 480-822-7638
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Fax |
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Provider Business Mailing Address
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Address Line | 422 E HAROLD DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-5689
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Country | US
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Telephone | 480-822-7638
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUREL HIRST
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Credential |
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Telephone | 480-822-7638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State | AZ
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Taxonomy #3
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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 | AZ
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