MEDICARE: SOUTHWEST PHYSIATRY PLLC

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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	44220

General Provider Information

NPI Number	:	1407367139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST PHYSIATRY PLLC

Provider Business Mailing Address
First Line	:	6807 N 14TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1133
Country	:	US
Telephone Number	:	617-538-3650
Fax Number	:	888-384-2827

Provider Business Practice Location Address
First Line	:	4550 E BELL RD STE 152
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-9382
Country	:	US
Telephone Number	:	617-538-3650
Fax Number	:	888-384-2827

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL CRINCOLI
Credential	:	MD
Telephone Number	:	617-538-3650

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	10/06/2025

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