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General NPI Number Information
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NPI Number | 1811628191
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Entity Type | Organization
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Legal Business Name | SOUTHWEST SPORTS MEDICINE AND REHABILITATION LLC
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Dates
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Enumeration Date | 06/18/2022
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 3330 N 2ND ST STE 401
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City | PHOENIX
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State | AZ
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Zip | 85012-2371
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Country | US
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Telephone | 602-606-9619
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2253
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City | PHOENIX
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State | AZ
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Zip | 85002-2253
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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 | OWNER
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Name | DR. CHRISTOPHER MENDIAS
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Credential | PHD, ATC
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Telephone | 602-606-9619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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