MEDICARE: NORTHERN ARIZONA REHABILITATION & FITNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	13044799E	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073515235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN ARIZONA REHABILITATION & FITNESS

Provider Business Mailing Address
First Line	:	450 S WILLARD ST
Second Line	:	STE 106
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-6744
Country	:	US
Telephone Number	:	928-649-9726
Fax Number	:	928-634-2079

Provider Business Practice Location Address
First Line	:	450 S WILLARD ST
Second Line	:	STE 106
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-6744
Country	:	US
Telephone Number	:	928-649-9726
Fax Number	:	928-634-2079

Authorized Official
Title or Position	:	RECEPTIONIST
Name	:	MRS. CINDY MARIE MESA
Credential	:
Telephone Number	:	928-649-9726

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/09/2008

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Directions to “NORTHERN ARIZONA REHABILITATION & FITNESS ” Practice Location

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