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General NPI Number Information
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NPI Number | 1902669807
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Entity Type | Organization
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Legal Business Name | AVAYA THERAPY OF ARIZONA LLC
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 18185 N 83RD AVE STE 206
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City | GLENDALE
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State | AZ
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Zip | 85308-0519
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Country | US
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Telephone | 708-408-2258
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Fax |
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Provider Business Mailing Address
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Address Line | 18185 N 83RD AVE STE 206
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City | GLENDALE
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State | AZ
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Zip | 85308-0519
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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 | MEMBER
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Name | ROLANDO ARROJO
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Credential |
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Telephone | 312-404-9639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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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 | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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