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General NPI Number Information
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NPI Number | 1821674086
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Entity Type | Organization
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Legal Business Name | INJURY DIAGNOSTICS LLC
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 3201 W PEORIA AVE STE B301
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City | PHOENIX
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State | AZ
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Zip | 85029-4618
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Country | US
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Telephone | 480-542-5590
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Fax | 480-542-5591
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Provider Business Mailing Address
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Address Line | 3201 W PEORIA AVE STE B301
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City | PHOENIX
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State | AZ
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Zip | 85029-4618
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Country | US
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Telephone | 480-542-5590
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Fax | 480-542-5591
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MATTHEW RHODES
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Credential | FNP-BC
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Telephone | 480-542-5590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine 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 | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) 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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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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 | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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