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General NPI Number Information
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NPI Number | 1952917205
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE OF MESA LLC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 3614 E SOUTHERN AVE STE 105
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City | MESA
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State | AZ
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Zip | 85206-2510
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Country | US
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Telephone | 602-354-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 21001 N TATUM BLVD STE 1630-606
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City | PHOENIX
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State | AZ
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Zip | 85050-4242
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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 | MANAGER
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Name | THOMAS MOSHIRI
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Credential |
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Telephone | 602-441-3573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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