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General NPI Number Information
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NPI Number | 1770813594
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Entity Type | Organization
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Legal Business Name | CUSTOM PHYSIOTHERAPY
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 03/22/2015
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Provider Practice Location Address
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Address Line | 4910 W RAY RD STE 2
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City | CHANDLER
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State | AZ
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Zip | 85226-6221
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Country | US
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Telephone | 480-855-0557
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Fax | 480-855-5937
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Provider Business Mailing Address
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Address Line | 4910 W RAY RD STE 2
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City | CHANDLER
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State | AZ
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Zip | 85226-6221
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Country | US
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Telephone | 480-855-0557
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Fax | 480-855-5937
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Authorized Official
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Title or Position | PHYSIOTHERAPIST
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Name | QUE KARBASSY
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Credential |
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Telephone | 480-855-0557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 4402
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License Number State | AZ
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