MEDICARE: ZANCAM LLC

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	261QP2000X	Physical Therapy Clinic/Center	2089	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330040	OTHER	AZ	PHCS
2	0463340	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073712998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZANCAM LLC

Provider Business Mailing Address
First Line	:	2253 E HALE ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-4012
Country	:	US
Telephone Number	:	602-418-7031
Fax Number	:	480-610-9811

Provider Business Practice Location Address
First Line	:	1919 E MCKELLIPS RD
Second Line	:	STE. 106
City	:	MESA
State	:	AZ
Zip	:	85203-2844
Country	:	US
Telephone Number	:	602-418-7031
Fax Number	:	480-610-9810

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	MRS. ANGELA RAE JOWAISZAS
Credential	:	P.T.
Telephone Number	:	602-418-7031

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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Directions to “ZANCAM LLC ” Practice Location

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