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General NPI Number Information
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NPI Number | 1891898177
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Entity Type | Organization
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Legal Business Name | CAMP VERDE PHYSICAL REHABILTATION
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 522 WEST FINNEY FLATS RD, SUITE D
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City | CAMP VERDE
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State | AZ
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Zip | 86322
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Country | US
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Telephone | 928-567-0987
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Fax | 928-567-5562
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Provider Business Mailing Address
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Address Line | PO BOX 3748
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City | CAMP VERDE
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State | AZ
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Zip | 86322-3748
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Country | US
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Telephone | 928-567-0987
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Fax | 928-567-5562
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Authorized Official
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Title or Position | OWNER
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Name | VIVIAN M PACE
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Credential | MPT
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Telephone | 928-567-0987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2149
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License Number State | AZ
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